Basic Information
| Provider Information | |||||||||
| NPI: | 1124026265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDEL | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | MYRON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 369 93RD ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112096901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186806000 | ||||||||
| FaxNumber: | 7186803682 | ||||||||
| Practice Location | |||||||||
| Address1: | 369 93RD ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112096901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186806000 | ||||||||
| FaxNumber: | 7186803682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 12/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 094638 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 112492182 | 01 | NY | PROVIDER ID# | OTHER |