Basic Information
| Provider Information | |||||||||
| NPI: | 1285636175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDELL | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1490 BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HEWLETT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115571432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165692900 | ||||||||
| FaxNumber: | 5165693442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1490 BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | HEWLETT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115571432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165692900 | ||||||||
| FaxNumber: | 5165693442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 126020-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00276022 | 05 | NY | MEDICAID |