M. H. Mandelbaum Orthotic & Prosthetic Services, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

M. H. MANDELBAUM ORTHOTIC & PROSTHETIC SERVICES, INC.

Practice address

3 Medical Dr Ste C
Port Jefferson Station, NY 11776-1597

Phone

(631) 473-8668

Fax

(631) 473-8691

NPI assigned

Jun 17, 2005

Organization subpart

No

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

Authorized official

Name

Solomon Heifetz

Title

Practice Manager

Phone

(631) 473-8668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1356346068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR STE C",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-473-8668",
            "fax_number": "631-473-8691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 MEDICAL DR STE C",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761597",
            "telephone_number": "631-473-8668",
            "fax_number": "631-473-8691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M. H. MANDELBAUM ORTHOTIC & PROSTHETIC SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "HEIFETZ",
        "authorized_official_first_name": "SOLOMON",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "631-473-8668"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00810646",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristina Lucci, OTR
• Sopheya Luckoo
• Sean Lynch, DPM
• Melissa Lynn, R.N.
• M & a Wellness Corporation
• Allison Michele Maccarello, LCSW
• Kumar Madom, MD
• Michael Magistro, ATC
• Danielle Maher, M.S.
• Kaitlyn Maiello-Buckley, NP

• Prosthetic/Orthotic Supplier in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Prosthetic/Orthotic Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.