Provider Demographics
NPI:1326075136
Name:MEHLMAN, IRA (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:MEHLMAN
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 1:1520 YORK AVE
Mailing Address - Street 2:SUITE 23 D
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7011
Mailing Address - Country:US
Mailing Address - Phone:212-717-4693
Mailing Address - Fax:
Practice Address - Street 1:1520 YORK AVE
Practice Address - Street 2:SUITE 23 D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7008
Practice Address - Country:US
Practice Address - Phone:212-717-4693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE63767Medicare UPIN