Provider Demographics
NPI:1629743562
Name:MIMOSA FAMILY HEALTH PC
Entity Type:Organization
Organization Name:MIMOSA FAMILY HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-486-9800
Mailing Address - Street 1:200 WALLABOUT ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:960 W 41ST ST STE 312
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3348
Practice Address - Country:US
Practice Address - Phone:718-486-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty