Provider Demographics
NPI:1083721583
Name:PRICE, MITCHELL R (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:R
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2200
Mailing Address - Country:US
Mailing Address - Phone:718-226-1850
Mailing Address - Fax:718-226-1334
Practice Address - Street 1:378 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2200
Practice Address - Country:US
Practice Address - Phone:718-226-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1720412086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03524045Medicaid
NYA400077485Medicare PIN
NJG38058Medicare UPIN