Provider Demographics
NPI:1316421043
Name:MANDELBAUM, YONATAN Y (PSYD)
Entity type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:Y
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 JOHNSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3539
Mailing Address - Country:US
Mailing Address - Phone:347-719-3078
Mailing Address - Fax:
Practice Address - Street 1:3265 JOHNSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3539
Practice Address - Country:US
Practice Address - Phone:347-719-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00599400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical