Provider Demographics
NPI:1003975889
Name:MITTAL, NARESH C
Entity Type:Individual
Prefix:MR
First Name:NARESH
Middle Name:C
Last Name:MITTAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EASTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6404
Mailing Address - Country:US
Mailing Address - Phone:845-425-2074
Mailing Address - Fax:
Practice Address - Street 1:49 EASTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6404
Practice Address - Country:US
Practice Address - Phone:845-425-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist