Provider Demographics
NPI:1548378573
Name:FENSTER, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:FENSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:190 GOLDENS BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536
Mailing Address - Country:US
Mailing Address - Phone:914-401-8053
Mailing Address - Fax:914-232-3366
Practice Address - Street 1:401 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1325
Practice Address - Country:US
Practice Address - Phone:914-769-0268
Practice Address - Fax:914-769-6303
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY153600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A63324Medicare UPIN