Provider Demographics
NPI:1760425102
Name:MANDEL, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1061
Mailing Address - Country:US
Mailing Address - Phone:212-348-3009
Mailing Address - Fax:212-369-0480
Practice Address - Street 1:1049 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1061
Practice Address - Country:US
Practice Address - Phone:212-348-3009
Practice Address - Fax:212-369-0480
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023559E2084N0400X
NJ25MA055195002084N0400X
NY129153-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ768658DAVMedicare PIN
NYA400065601Medicare PIN
C32207Medicare UPIN
PA588025KGBMedicare PIN