Provider Demographics
NPI:1053362103
Name:MANDYCH, ALEXANDER KENDRAT (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:KENDRAT
Last Name:MANDYCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3075 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-675-0616
Mailing Address - Fax:716-675-7101
Practice Address - Street 1:3075 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-675-0616
Practice Address - Fax:716-675-7101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY191510207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1243Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NYG75601Medicare UPIN