Mark Vincent Mandala

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

027420 Issued in NY

Practice address

163 William St FL 5
New York, NY 10038-2613

Phone

(212) 618-6052

NPI assigned

Aug 24, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maimonides Medical Center Orthopaedic FPPGroup PAC ID 1850694431, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maimonides Medical Center Orthopaedic FPP

  • Orthopaedic Surgery Physician
  • Brooklyn, NY
  • NPI 1073943163
  Medicare reassignment Care Compare group
• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment
• Kings Highway Orthopedic Assoc PC

  • General Practice Physician
  • Brooklyn, NY
  • NPI 1659458685
  NPD (past)
• Maimonides Bone and Joint Faculty Practice Physical Therapy

  • Rehabilitation Clinic/Center
  • Brooklyn, NY
  • NPI 1609431576
  NPD (past)

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1497422968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 WILLIAM ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100382613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 WILLIAM ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100382613",
            "telephone_number": "212-618-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDALA",
        "first_name": "MARK",
        "middle_name": "VINCENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-24",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "027420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terezia Manczur, M.D.
• Nektaria Mandadakis, O.D.
• Kunal Mandal, PHARM.D.
• Carly Anne Mandala, PA-C
• Kristina Mandala
• Thomas Mandala, PT, DPT, SCS, CSCS
• Sunil Mandalapu, RPH
• Mandalay Dental Care PC
• Leighia Willis Mandanas, R.PH.
• Dro Mandani

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.