Provider Demographics
NPI:1124005764
Name:MITTMAN, HERBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:
Last Name:MITTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 INDEPENDENCE AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6225
Mailing Address - Country:US
Mailing Address - Phone:718-884-3221
Mailing Address - Fax:718-884-3226
Practice Address - Street 1:2550 INDEPENDENCE AVE
Practice Address - Street 2:APT 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6225
Practice Address - Country:US
Practice Address - Phone:718-884-3221
Practice Address - Fax:718-884-3226
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2125213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405147Medicaid
NYP18311Medicare UPIN
NYP18311Medicare ID - Type Unspecified