Provider Demographics
NPI:1386657658
Name:GEIZHALS, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:GEIZHALS
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 1:11724 PARK LN S
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1021
Mailing Address - Country:US
Mailing Address - Phone:718-850-7475
Mailing Address - Fax:718-228-5899
Practice Address - Street 1:7823 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2928
Practice Address - Country:US
Practice Address - Phone:718-326-1998
Practice Address - Fax:718-360-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00964865Medicaid
NY03000Medicare PIN
NY00964865Medicaid
NYA64132Medicare UPIN