Provider Demographics
NPI:1336122209
Name:MANDELMAN, JOEL M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:MANDELMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3744
Mailing Address - Country:US
Mailing Address - Phone:718-252-0100
Mailing Address - Fax:
Practice Address - Street 1:1050 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3744
Practice Address - Country:US
Practice Address - Phone:718-252-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN03417213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00740950Medicaid
T51094Medicare UPIN
NY00740950Medicaid