Basic Information
| Provider Information | |||||||||
| NPI: | 1467510149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANDELBAUM | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CCC-A, CNIM | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MANDELBAUM | ||||||||
| OtherFirstName: | YOSSI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CCC-A, CNIM | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1086 TEANECK RD STE 4A | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018629900 | ||||||||
| FaxNumber: | 2018629136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1086 TEANECK RD STE 4A | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018629900 | ||||||||
| FaxNumber: | 2018629136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1164 | NY | X | Other Service Providers | Specialist | 231H00000X | 001996-1 | NY | X | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 41YA00068300 | NJ | X | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | MG0001063 | NY | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.