Provider Demographics
NPI:1518122365
Name:MANDEL, ELLEN D (PA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:MANDEL
Suffix:
Gender:F
Credentials:PA
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Other - Middle Name:
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Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-277-8602
Mailing Address - Fax:908-673-7132
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8602
Practice Address - Fax:908-673-7132
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00023000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant