Provider Demographics
NPI:1710080726
Name:MARK A. MANDEL, D.C., P.C.
Entity Type:Organization
Organization Name:MARK A. MANDEL, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:631-543-4242
Mailing Address - Street 1:66 MARIE CRES
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5221
Mailing Address - Country:US
Mailing Address - Phone:631-543-4242
Mailing Address - Fax:
Practice Address - Street 1:66 MARIE CRES
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5221
Practice Address - Country:US
Practice Address - Phone:631-543-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2058111N00000X
NY1016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13331Medicare ID - Type Unspecified