Provider Demographics
NPI:1528294246
Name:MANDEL THERAPY GROUP
Entity type:Organization
Organization Name:MANDEL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-364-7570
Mailing Address - Street 1:8842 STATE ROUTE 90 N
Mailing Address - Street 2:
Mailing Address - City:KING FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:13081
Mailing Address - Country:US
Mailing Address - Phone:315-364-7570
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 STATE ROUTE 90 N
Practice Address - Street 2:
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019054-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty