Provider Demographics
NPI:1679776835
Name:MANDELL & BLAU, MD'S PC
Entity Type:Organization
Organization Name:MANDELL & BLAU, MD'S PC
Other - Org Name:OPEN MRI OF GLASTONBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-633-8806
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-0230
Mailing Address - Country:US
Mailing Address - Phone:860-633-8806
Mailing Address - Fax:860-657-3788
Practice Address - Street 1:124 HEBRON AVE STE 1B
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2063
Practice Address - Country:US
Practice Address - Phone:860-657-2242
Practice Address - Fax:860-657-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT294659OtherWELCARE/PREFERRED ONE
CT4000931Medicaid
CT780678OtherCONNECTICARE
CT15MRI0016CT03OtherANTHEM BC/BS
CTCF9509OtherRAILROAD MEDICARE
CT2V0862OtherHEALTHNET
CTA369503OtherOXFORD
CTC02758Medicare PIN