Provider Demographics
NPI:1972531366
Name:MANDEL, EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
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 1:3041 AVENUE U
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5126
Mailing Address - Country:US
Mailing Address - Phone:718-692-0020
Mailing Address - Fax:718-692-1739
Practice Address - Street 1:3041 AVENUE U
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5126
Practice Address - Country:US
Practice Address - Phone:718-692-0020
Practice Address - Fax:718-692-1739
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150681-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY340004641OtherMEDICARE RAILROAD
NY86D591Medicare PIN
NYG400000943Medicare PIN
NY01134Medicare PIN
NY86D59EL851Medicare PIN