Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 034846 | NY |
NPI | 1003114976 |
---|---|
Provider Name | Dr. Michael J Mand |
First Address | Brooklyn, NY 11232-3083 |
Second Address | Brooklyn, NY 11232-3083 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2011 |
Last Update Date | 09/02/2016 |