Provider Demographics
NPI:1669472676
Name:BOXER, MITCHELL BARRY (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:BARRY
Last Name:BOXER
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 1:560 NORTHERN BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-0910
Mailing Address - Fax:516-482-0943
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-0910
Practice Address - Fax:516-482-0943
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154324207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
B20310Medicare UPIN
95D731Medicare PIN
95D732Medicare PIN