Provider Demographics
NPI:1326272212
Name:MITTAL, MONA (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:MITTAL
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:MITTAL
Other - Last Name:KRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 ROUTE 9D
Mailing Address - Street 2:VA HUDSON VALLEY
Mailing Address - City:CASTLE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12511
Mailing Address - Country:US
Mailing Address - Phone:845-831-2000
Mailing Address - Fax:
Practice Address - Street 1:100 ROUTE 9D
Practice Address - Street 2:VA HUDSON VALLEY
Practice Address - City:CASTLE POINT
Practice Address - State:NY
Practice Address - Zip Code:12511
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2618942083P0901X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program