Provider Demographics
NPI:1285767012
Name:MARC MANDEL MD PC
Entity type:Organization
Organization Name:MARC MANDEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-855-7989
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:CO ADVANTAGE MEDICAL BILLING INC
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07091-2876
Mailing Address - Country:US
Mailing Address - Phone:908-654-6670
Mailing Address - Fax:908-789-5550
Practice Address - Street 1:1030 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1390
Practice Address - Country:US
Practice Address - Phone:732-855-7989
Practice Address - Fax:732-855-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48956208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ723217Medicare ID - Type Unspecified