Provider Demographics
NPI:1629456868
Name:MANDELBAUM, DEBRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1313
Mailing Address - Country:US
Mailing Address - Phone:516-236-4657
Mailing Address - Fax:
Practice Address - Street 1:625 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4952
Practice Address - Country:US
Practice Address - Phone:973-574-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0593451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist