Provider Demographics
NPI:1467510149
Name:MANDELBAUM, JOSEPH (CCC-A, CNIM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:CCC-A, CNIM
Other - Prefix:
Other - First Name:YOSSI
Other - Middle Name:
Other - Last Name:MANDELBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-A, CNIM
Mailing Address - Street 1:1086 TEANECK RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4858
Mailing Address - Country:US
Mailing Address - Phone:201-862-9900
Mailing Address - Fax:201-862-9136
Practice Address - Street 1:1086 TEANECK RD STE 4A
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4858
Practice Address - Country:US
Practice Address - Phone:201-862-9900
Practice Address - Fax:201-862-9136
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1164174400000X
NY001996-1231H00000X
NJ41YA00068300231H00000X
NYMG0001063237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter