Provider Demographics
NPI:1780887950
Name:MANDELL & BLAU, MD'S PC
Entity type:Organization
Organization Name:MANDELL & BLAU, MD'S PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-633-8806
Mailing Address - Street 1:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-0230
Mailing Address - Country:US
Mailing Address - Phone:860-657-2242
Mailing Address - Fax:860-657-2264
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:METRO SQUARE
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3437
Practice Address - Country:US
Practice Address - Phone:860-633-8806
Practice Address - Fax:860-346-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA369503OtherOXFORD
CTCJ5750OtherRAILROAD MEDICARE
CT2V0862OtherHEALTHNET
CT060857OtherCONNECTICARE
CT15MRI0016CT05OtherANTHEM BC/BS
CT222094OtherWELLCARE/PREFERRED ONE
CT4000931Medicaid
CT4000931Medicaid