Provider Demographics
NPI:1063472710
Name:MANDELSTAM, ARNOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:
Last Name:MANDELSTAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 190TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1039
Mailing Address - Country:US
Mailing Address - Phone:718-479-6699
Mailing Address - Fax:718-776-6551
Practice Address - Street 1:80-44 190 ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11423-1309
Practice Address - Country:US
Practice Address - Phone:718-479-6699
Practice Address - Fax:718-776-6551
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1491582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00759875Medicaid
93A533Medicare ID - Type Unspecified
NY00759875Medicaid
44M061Medicare ID - Type Unspecified
55900Medicare ID - Type Unspecified