Provider Demographics
NPI:1841279924
Name:MANDELBAUM, BERT (MD)
Entity type:Individual
Prefix:DR
First Name:BERT
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:301 N HARRISON ST
Mailing Address - Street 2:PRINCETON NASSAU PEDIATRICS
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3512
Mailing Address - Country:US
Mailing Address - Phone:609-924-3441
Mailing Address - Fax:609-924-3410
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:PRINCETON NASSAU PEDIATRICS
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3512
Practice Address - Country:US
Practice Address - Phone:609-924-3441
Practice Address - Fax:609-924-3410
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA072236002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine