Provider Demographics
NPI:1285636175
Name:MANDELL, BARBARA C (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:MANDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1432
Mailing Address - Country:US
Mailing Address - Phone:516-569-2900
Mailing Address - Fax:516-569-3442
Practice Address - Street 1:1490 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1432
Practice Address - Country:US
Practice Address - Phone:516-569-2900
Practice Address - Fax:516-569-3442
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126020-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00276022Medicaid
A58624Medicare UPIN
NY00276022Medicaid