Provider Demographics
NPI:1558060756
Name:VINCENT MANDATO
Entity Type:Organization
Organization Name:VINCENT MANDATO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDATO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-896-4416
Mailing Address - Street 1:338 FORTUNA DR
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-3350
Mailing Address - Country:US
Mailing Address - Phone:215-896-4116
Mailing Address - Fax:
Practice Address - Street 1:338 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-3350
Practice Address - Country:US
Practice Address - Phone:215-896-4116
Practice Address - Fax:215-855-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric