Provider Demographics
NPI:1639173008
Name:MAYER, MITCHELL F (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:F
Last Name:MAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GILL LN
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3001
Mailing Address - Country:US
Mailing Address - Phone:732-404-1580
Mailing Address - Fax:732-404-1594
Practice Address - Street 1:400 GILL LN
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3001
Practice Address - Country:US
Practice Address - Phone:732-404-1580
Practice Address - Fax:732-404-1594
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB48348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54765Medicare UPIN