Individual
IRWIN MANSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
15230 JEWEL AVE, FLUSHING, NY 11367-1436
(718) 809-6871
(718) 809-6871
Mailing address
15230 JEWEL AVE, FLUSHING, NY 11367-1436
(718) 809-6871
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
005396
NY
103TC0700X
Clinical Psychologist
4588
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00991497
—
NY
01
—
0340EY
GHI MEDICARE
—
Enumeration date
06/30/2006
Last updated
09/07/2016
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