Provider Demographics
NPI:1467476036
Name:ERIC R. MANDEL M.D P.C.
Entity Type:Organization
Organization Name:ERIC R. MANDEL M.D P.C.
Other - Org Name:MANDELVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-734-0111
Mailing Address - Street 1:211 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5205
Mailing Address - Country:US
Mailing Address - Phone:212-734-0111
Mailing Address - Fax:212-628-2515
Practice Address - Street 1:211 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5205
Practice Address - Country:US
Practice Address - Phone:212-734-0111
Practice Address - Fax:212-628-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0Z081Medicare ID - Type Unspecified