Provider Demographics
NPI:1720421001
Name:MANDEL, IRINA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340C RAMAPO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2711
Mailing Address - Country:US
Mailing Address - Phone:973-962-6200
Mailing Address - Fax:973-962-0046
Practice Address - Street 1:340C RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2711
Practice Address - Country:US
Practice Address - Phone:973-962-6200
Practice Address - Fax:973-962-0046
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00419100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7726805Medicaid
NJ7726805Medicaid
NJD07056Medicare UPIN