Provider Demographics
NPI:1720045487
Name:MITTLER, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MITTLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1101
Mailing Address - Country:US
Mailing Address - Phone:516-354-3401
Mailing Address - Fax:516-354-8597
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1101
Practice Address - Country:US
Practice Address - Phone:516-354-3401
Practice Address - Fax:516-354-8597
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY213060207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02055338Medicaid
NY02055338Medicaid
NY90E921Medicare ID - Type Unspecified