Provider Demographics
NPI:1447421458
Name:THADDEUS WANDEL M. D., P. C.
Entity Type:Organization
Organization Name:THADDEUS WANDEL M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-271-5026
Mailing Address - Street 1:136 OLD POST RD N
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1934
Mailing Address - Country:US
Mailing Address - Phone:914-271-5026
Mailing Address - Fax:914-271-6592
Practice Address - Street 1:136 OLD POST RD N
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1934
Practice Address - Country:US
Practice Address - Phone:914-271-5026
Practice Address - Fax:914-271-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098683207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00168263Medicaid
NYB17545Medicare UPIN
NY652603Medicare PIN
NY00168263Medicaid