Provider Demographics
NPI:1932273612
Name:JOSEPH MANDELBAUM, M.D. AND CRAIG R. SMOLOW, M.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH MANDELBAUM, M.D. AND CRAIG R. SMOLOW, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERED
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-437-7202
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:ST N204
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-437-7202
Mailing Address - Fax:516-437-7602
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:ST N204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-437-7202
Practice Address - Fax:516-437-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080880207R00000X
NY139589207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW18481Medicare ID - Type Unspecified