Provider Demographics
NPI:1336479880
Name:MANDEL, MOLLIE MALKA (NP)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:MALKA
Last Name:MANDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:115 10 QUEENS BOULVARD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:347-563-1588
Mailing Address - Fax:718-544-0972
Practice Address - Street 1:11109 76TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6466
Practice Address - Country:US
Practice Address - Phone:347-563-1588
Practice Address - Fax:718-544-0972
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY335037364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health