Provider Demographics
NPI:1477585008
Name:EPSTEIN, MITCHELL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:R
Last Name:EPSTEIN
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 1:3131 KINGS HWY
Mailing Address - Street 2:SUITE D9
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2644
Mailing Address - Country:US
Mailing Address - Phone:718-258-7474
Mailing Address - Fax:718-253-9024
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE D9
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-258-7474
Practice Address - Fax:718-253-9024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125438174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00298917Medicaid
NYB80459Medicare UPIN
NY337681Medicare ID - Type Unspecified