Provider Demographics
NPI:1376565812
Name:MITTLEMAN, JOEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:MITTLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3005
Mailing Address - Country:US
Mailing Address - Phone:212-684-1882
Mailing Address - Fax:212-684-1886
Practice Address - Street 1:19 E 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3005
Practice Address - Country:US
Practice Address - Phone:212-684-1882
Practice Address - Fax:212-684-1886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU74408Medicare UPIN
NYX6B741Medicare ID - Type Unspecified