Individual provider Active NPI

Donald Myron Mandel, M.D.

  • Internal Medicine Physician
  • Brooklyn, NY
National Provider Identifier
1124026265
Registry record updated Dec 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
094638 Issued in NY
Practice address
369 93Rd St
Brooklyn, NY 11209-6901
Phone
(718) 680-6000
Fax
(718) 680-3682
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 094638 NY Primary

Addresses

Primary practice location

369 93Rd St
Brooklyn, NY 11209-6901

Mailing address

369 93Rd St
Brooklyn, NY 11209-6901
Phone (718) 680-6000

Other identifiers 1

IdentifierTypeStateIssuer
112492182OtherNYPROVIDER ID#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181017003315 NY Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1658414230

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
094638NYMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262131200000",
    "number": "1124026265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 93RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112096901",
            "telephone_number": "718-680-6000",
            "fax_number": "718-680-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 93RD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112096901",
            "telephone_number": "718-680-6000",
            "fax_number": "718-680-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "DONALD",
        "middle_name": "MYRON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2009-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "094638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER ID#",
            "identifier": "112492182",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.