Provider Demographics
NPI:1952572224
Name:MANDELBAUM, RACHEL A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:BENSADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:275 W 238TH ST
Mailing Address - Street 2:3K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2308
Mailing Address - Country:US
Mailing Address - Phone:718-543-2437
Mailing Address - Fax:
Practice Address - Street 1:110 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:212-531-7514
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565210163W00000X
NYF304697364SA2200X
NYF420855364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health