Provider Demographics
NPI:1285858894
Name:TURNER, MITCHELL S (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:TURNER
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 1:1945 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3526
Mailing Address - Country:US
Mailing Address - Phone:908-688-7546
Mailing Address - Fax:908-688-8894
Practice Address - Street 1:1945 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3526
Practice Address - Country:US
Practice Address - Phone:908-688-7546
Practice Address - Fax:908-688-8894
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5183308Medicaid
723868Medicare ID - Type Unspecified
NJ5183308Medicaid