Provider Demographics
NPI:1780005637
Name:IRA B MITTLEMAN, DC, PC
Entity Type:Organization
Organization Name:IRA B MITTLEMAN, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MITTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-488-4044
Mailing Address - Street 1:181 LANDAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1034
Mailing Address - Country:US
Mailing Address - Phone:516-488-4044
Mailing Address - Fax:
Practice Address - Street 1:181 LANDAU AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1034
Practice Address - Country:US
Practice Address - Phone:516-488-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty