Provider Demographics
NPI:1790102820
Name:WITONSKY, MITCHELL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WITONSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:1656 CHAMPLAIN AVENUE
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13503-0479
Mailing Address - Country:US
Mailing Address - Phone:315-624-6010
Mailing Address - Fax:315-624-6357
Practice Address - Street 1:1656 CHAMPLAIN AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13503-0479
Practice Address - Country:US
Practice Address - Phone:315-624-6010
Practice Address - Fax:315-624-6357
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist