Provider Demographics
NPI:1740494624
Name:MANDICH, BORISLAVA (MD)
Entity type:Individual
Prefix:DR
First Name:BORISLAVA
Middle Name:
Last Name:MANDICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BOOMINGDALE ROAD
Mailing Address - Street 2:NEW YORK PRESBYTERIAN HOSPITAL, WESTCHESTER DIVISION
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605
Mailing Address - Country:US
Mailing Address - Phone:914-997-5726
Mailing Address - Fax:914-682-6988
Practice Address - Street 1:21 BOOMINGDALE ROAD
Practice Address - Street 2:NEW YORK PRESBYTERIAN HOSPITAL, WESTCHESTER DIVISION
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605
Practice Address - Country:US
Practice Address - Phone:914-997-5726
Practice Address - Fax:914-682-6988
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1345112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
14D511Medicare ID - Type Unspecified