Provider Demographics
NPI:1811235997
Name:BLUTT, MITCHELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:J
Last Name:BLUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 W 86TH ST
Mailing Address - Street 2:217
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3332
Mailing Address - Country:US
Mailing Address - Phone:917-572-9175
Mailing Address - Fax:212-660-8098
Practice Address - Street 1:225 W 86TH ST
Practice Address - Street 2:217
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3332
Practice Address - Country:US
Practice Address - Phone:917-572-9175
Practice Address - Fax:212-660-8098
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154784-1207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine