Basic Information
Provider Information
NPI: 1043254568
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MANDEL
FirstName: SCOTT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 MARCUS AVE
Address2:  
City: NEW HYDE PARK
State: NY
PostalCode: 110421113
CountryCode: US
TelephoneNumber: 5166226000
FaxNumber:  
Practice Location
Address1: 1010 NORTHERN BLVD
Address2: SUITE 110
City: GREAT NECK
State: NY
PostalCode: 110215317
CountryCode: US
TelephoneNumber: 5163902400
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/15/2006
LastUpdateDate: 11/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X190301NYY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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