Provider Demographics
NPI:1083828495
Name:MITZNER, RON (MD)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:MITZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:6 OHIO DR STE 202
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1129
Practice Address - Country:US
Practice Address - Phone:516-775-2800
Practice Address - Fax:516-775-0859
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT188339207Y00000X
NY260623207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400051871Medicare PIN