Basic Information
| Provider Information | |||||||||
| NPI: | 1366436404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRITI V MANDALAYWALA MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2001 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154492208 | ||||||||
| FaxNumber: | 3153625120 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136761228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152688240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANDALAYWALA | ||||||||
| AuthorizedOfficialFirstName: | PRITI | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3156828240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.