Provider Demographics
NPI:1801297320
Name:MANDEL, HAROLD
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2057
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13089-2057
Mailing Address - Country:US
Mailing Address - Phone:315-378-1349
Mailing Address - Fax:
Practice Address - Street 1:7608 OSWEGO RD
Practice Address - Street 2:#2057
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13089-5001
Practice Address - Country:US
Practice Address - Phone:315-200-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice