Provider Demographics
NPI:1891860755
Name:JENNIFER BAGG MD & PHYLLIS MANDEL MD PC
Entity Type:Organization
Organization Name:JENNIFER BAGG MD & PHYLLIS MANDEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BAGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-576-2010
Mailing Address - Street 1:1255 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:914-576-2010
Mailing Address - Fax:914-576-2529
Practice Address - Street 1:1255 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804
Practice Address - Country:US
Practice Address - Phone:914-576-2010
Practice Address - Fax:914-576-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181534207R00000X
NY184941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01735473Medicaid
E87574Medicare UPIN
NY01735473Medicaid
F77633Medicare UPIN
NY80F771Medicare ID - Type Unspecified