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General NPI Number Information
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NPI Number | 1811007545
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Entity Type | Organization
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Legal Business Name | MANDELL & BLAU, MD'S PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 491 BUCKLAND RD SUITE 3
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3732
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Country | US
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Telephone | 860-648-4674
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Fax | 860-648-2043
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | GLASTONBURY
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State | CT
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Zip | 06033-0230
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Country | US
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Telephone | 860-633-8806
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Fax | 860-657-3788
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEAL BARKOFF
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Credential | M.D.
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Telephone | 860-633-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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