Provider Demographics
NPI:1285648543
Name:MANDELL, MENACHEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MENACHEM
Middle Name:
Last Name:MANDELL
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 1:260 N ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1608
Mailing Address - Country:US
Mailing Address - Phone:845-353-0400
Mailing Address - Fax:845-353-5563
Practice Address - Street 1:260 N ROUTE 303
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1608
Practice Address - Country:US
Practice Address - Phone:845-353-0400
Practice Address - Fax:845-353-5563
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1628852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE84139Medicare UPIN
NY82F281Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID