Provider Demographics
NPI:1710464896
Name:MITCHELL, JUSTINE MARTIN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:JUSTINE
Middle Name:MARTIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:MR
Other - First Name:JUSTINE
Other - Middle Name:MARTIN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2195 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3529
Practice Address - Country:US
Practice Address - Phone:212-348-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY777798163W00000X
NY3156351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse