1578926952 NPI number — KARYN HARTZ-MANDELL PH.D.

Table of content: KARYN HARTZ-MANDELL PH.D. (NPI 1578926952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578926952 NPI number — KARYN HARTZ-MANDELL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTZ-MANDELL
Provider First Name:
KARYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578926952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 VETERANS MEMORIAL PKWY
Provider Second Line Business Mailing Address:
BRADLEY RESEARCH CENTER, CORO WEST, SUITE 204, 2.115
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02915-5061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-793-8860
Provider Business Mailing Address Fax Number:
401-793-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOPPIN ST
Provider Second Line Business Practice Location Address:
CORO WEST, SUITE 204, 2.115
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-793-8860
Provider Business Practice Location Address Fax Number:
401-793-8799
Provider Enumeration Date:
04/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  24448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: PS01550 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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