Active NPI
Robert Mandelbaum, CASAC
- Addiction (Substance Use Disorder) Counselor
- Shirley, NY
National Provider Identifier
1205035540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12388
- Practice address
- 151 Parkwood Dr
Shirley, NY 11967-3938 - Phone
- (631) 543-6200
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12388 | NY | Primary |
Addresses
Primary practice location
151 Parkwood Dr
Shirley, NY 11967-3938
Mailing address
151 Parkwood Dr
Shirley, NY 11967-3938
Phone (631) 543-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02249145 | Other | NY | CASAC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12388 | NY | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270425600000",
"number": "1205035540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 PARKWOOD DR",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673938",
"telephone_number": "631-543-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 PARKWOOD DR",
"city": "SHIRLEY",
"state": "NY",
"postal_code": "119673938",
"telephone_number": "631-543-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDELBAUM",
"first_name": "ROBERT",
"credential": "CASAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2010-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NY",
"license": "12388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CASAC",
"identifier": "02249145",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shirley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.