Provider Demographics
NPI:1326005521
Name:MANDEL, MARC STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:MANDEL
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 1:11 OVERLOOK RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3577
Mailing Address - Country:US
Mailing Address - Phone:908-598-0966
Mailing Address - Fax:908-598-0298
Practice Address - Street 1:11 OVERLOOK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3577
Practice Address - Country:US
Practice Address - Phone:908-598-0966
Practice Address - Fax:908-598-0298
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5549108Medicaid
NJE42891Medicare UPIN
NJ5549108Medicaid