Provider Demographics
NPI:1093977951
Name:PHYLLIS MANDEL MD PLLC
Entity Type:Organization
Organization Name:PHYLLIS MANDEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-235-2352
Mailing Address - Street 1:150 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4916
Mailing Address - Country:US
Mailing Address - Phone:914-235-2352
Mailing Address - Fax:914-235-3763
Practice Address - Street 1:150 LOCKWOOD AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4916
Practice Address - Country:US
Practice Address - Phone:914-235-2352
Practice Address - Fax:914-235-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF77633Medicare UPIN
NY35N041Medicare PIN