Provider Demographics
NPI:1083680003
Name:MITTAL, NIRANJAN KUMAR (MD,FACC)
Entity Type:Individual
Prefix:MR
First Name:NIRANJAN
Middle Name:KUMAR
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2704
Mailing Address - Country:US
Mailing Address - Phone:718-439-5111
Mailing Address - Fax:718-493-6108
Practice Address - Street 1:7404 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2704
Practice Address - Country:US
Practice Address - Phone:718-439-5111
Practice Address - Fax:718-493-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162509207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00911775Medicaid
NYA63478Medicare UPIN
NY00911775Medicaid