Provider Demographics
NPI:1437290475
Name:MANDEL, MARILYN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156-11 AGUILAR AVE.
Mailing Address - Street 2:STE 4G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2713
Mailing Address - Country:US
Mailing Address - Phone:718-306-7600
Mailing Address - Fax:212-867-0409
Practice Address - Street 1:315 MADISON AVENUE #200
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:718-306-7600
Practice Address - Fax:212-867-0409
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003263213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP35721Medicare PIN