Provider Demographics
NPI:1831225846
Name:MANDEL, DANA E (PT, PCS)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:E
Last Name:MANDEL
Suffix:
Gender:M
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8842 STATE ROUTE 90 N
Mailing Address - Street 2:
Mailing Address - City:KING FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:13081-8723
Mailing Address - Country:US
Mailing Address - Phone:315-364-7570
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:MANDEL THERAPY GROUP
Practice Address - Street 2:8842 STATE ROUT 90
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009347-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11226092OtherCAQH PROVIDER ID#
NYAA1614Medicare ID - Type Unspecified