Provider Demographics
NPI:1538299367
Name:MITCHELL J. MUTTERPERL MDPA
Entity Type:Organization
Organization Name:MITCHELL J. MUTTERPERL MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLJO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTTERPERL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-858-0090
Mailing Address - Street 1:19 W 33RD ST # B2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 W 33RD ST # B2
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3916
Practice Address - Country:US
Practice Address - Phone:201-858-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027546Medicare ID - Type Unspecified