Provider Demographics
NPI:1053070656
Name:MITCHEL ASHKANAZY
Entity Type:Organization
Organization Name:MITCHEL ASHKANAZY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHKANAZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-838-1211
Mailing Address - Street 1:170 KINNELON RD RM 27
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2351
Mailing Address - Country:US
Mailing Address - Phone:973-838-1211
Mailing Address - Fax:973-838-1251
Practice Address - Street 1:170 KINNELON RD RM 27
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2351
Practice Address - Country:US
Practice Address - Phone:973-838-1211
Practice Address - Fax:973-838-1251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHEL ASHKANAZY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA04065200OtherNJ DIVISION OF CONSUMER AFFAIRS - MEDICAL LICENSE