Individual
ANTHONY MANDESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
423 E 138TH ST, BRONX, NY 10454-3004
(718) 292-0100
Mailing address
6 HUMBOLDT ST, WOOD RIDGE, NJ 07075-2308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001307
NY
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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