Provider Demographics
NPI:1427000371
Name:MANTELL, BORIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:MANTELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3021
Mailing Address - Country:US
Mailing Address - Phone:718-646-8337
Mailing Address - Fax:718-934-5457
Practice Address - Street 1:3950 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3802
Practice Address - Country:US
Practice Address - Phone:718-391-0400
Practice Address - Fax:718-391-0777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263041835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy