Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 139190 | NY |
NPI | 1114008240 |
---|---|
Provider Name | Clemens A Mandel |
First Address | Woodhaven, NY 11421-1535 |
Second Address | Woodhaven, NY 11421-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |