Provider Demographics
NPI:1780997049
Name:MANDELL, JENNIFER (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MANDELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4100
Mailing Address - Country:US
Mailing Address - Phone:908-917-4717
Mailing Address - Fax:
Practice Address - Street 1:148 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-2157
Practice Address - Country:US
Practice Address - Phone:908-257-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01357000261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy