Provider Demographics
NPI:1598771008
Name:MINTZ, DOUGLAS N (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:N
Last Name:MINTZ
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 1:535 E 70TH ST
Mailing Address - Street 2:HOSPITAL FOR SPECIAL SURGERY - MRI
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-606-1982
Mailing Address - Fax:212-734-7378
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:HOSPITAL FOR SPECIAL SURGERY - MRI
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-606-1982
Practice Address - Fax:212-734-7378
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1926352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00637403Medicaid
NY01859856Medicaid
NYHS0W067410Medicare ID - Type UnspecifiedGROUP NUMBER
NY00637403Medicaid
F11745Medicare UPIN