Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 283904 | NY |
Y | 2080P0202X | Pediatric Cardiologist | 283904 | NY |
NPI | 1134562614 |
---|---|
Provider Name | Benjamin S Mantell |
First Address | New York, NY 10032-1559 |
Second Address | New York, NY 10032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 09/04/2019 |