Provider Demographics
NPI:1548379431
Name:MANDELBAUM, SIDNEY HENRY (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:HENRY
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5119
Mailing Address - Country:US
Mailing Address - Phone:212-650-0400
Mailing Address - Fax:212-288-4223
Practice Address - Street 1:178 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5119
Practice Address - Country:US
Practice Address - Phone:212-650-0400
Practice Address - Fax:212-288-4223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131138-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64100Medicare UPIN
NY74D611Medicare ID - Type Unspecified