Provider Demographics
NPI:1689236499
Name:MANDELBAUM, ELIEZER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1314
Mailing Address - Country:US
Mailing Address - Phone:718-930-8386
Mailing Address - Fax:
Practice Address - Street 1:7 WENDOVER LN
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4008
Practice Address - Country:US
Practice Address - Phone:718-930-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist