Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 039298 | NY |
NPI | 1033202510 |
---|---|
Provider Name | Dr. David Abraham Mandel |
First Address | New City, NY 10956-6110 |
Second Address | Bronx, NY 10468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |