Provider Demographics
NPI:1093875908
Name:MITCHELL, ROBERT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:MITCHELL
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 1:110 E END AVE
Mailing Address - Street 2:SUITE 1-M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7412
Mailing Address - Country:US
Mailing Address - Phone:212-288-6164
Mailing Address - Fax:
Practice Address - Street 1:110 E END AVE
Practice Address - Street 2:SUITE 1-M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7412
Practice Address - Country:US
Practice Address - Phone:212-288-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1457782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10163Medicare UPIN