Provider Demographics
NPI:1952403594
Name:MANDEL, MARK ALEX (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALEX
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MARIE CRES
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5221
Mailing Address - Country:US
Mailing Address - Phone:631-543-4242
Mailing Address - Fax:631-543-0801
Practice Address - Street 1:66 MARIE CRES
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5221
Practice Address - Country:US
Practice Address - Phone:631-543-4242
Practice Address - Fax:163-543-0801
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2058111N00000X
NY1016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX13331Medicare ID - Type Unspecified