Provider Demographics
NPI:1255482295
Name:MITCHELL, DEAN CORY (MD)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:CORY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:165 NORTH VIALLGE AVENUE
Mailing Address - Street 2:SUITE #129
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-678-9600
Mailing Address - Fax:516-678-9618
Practice Address - Street 1:57 W 57TH ST STE 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-397-0157
Practice Address - Fax:212-586-6880
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY170802207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY261707718OtherTAX IDENTIFICATION NUMBER
NY261707718OtherTAX IDENTIFICATION NUMBER
NYE62964Medicare UPIN