MEDICARE: PAIGE MANDEL MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86152295

General Provider Information

NPI Number	:	1780275198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE MANDEL MS, RD

Provider Business Mailing Address
First Line	:	300 E 34TH ST APT 15G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 34TH ST APT 15G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5213
Country	:	US
Telephone Number	:	516-712-0720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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