Provider Demographics
NPI:1316141724
Name:MANDEL, MIRONA (CNM)
Entity type:Individual
Prefix:
First Name:MIRONA
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 NEW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1548
Mailing Address - Country:US
Mailing Address - Phone:845-271-3222
Mailing Address - Fax:845-272-3334
Practice Address - Street 1:85 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1548
Practice Address - Country:US
Practice Address - Phone:845-271-3222
Practice Address - Fax:845-272-3334
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYOOO587367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife