Provider Demographics
NPI:1851319248
Name:SATISH K. MITTAL
Entity Type:Organization
Organization Name:SATISH K. MITTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-691-4800
Mailing Address - Street 1:112 RUNNING DEER TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4186
Mailing Address - Country:US
Mailing Address - Phone:856-691-4800
Mailing Address - Fax:856-691-4801
Practice Address - Street 1:2950 COLLEGE DR STE 1C
Practice Address - Street 2:SUITE # 1-C
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6933
Practice Address - Country:US
Practice Address - Phone:856-691-4800
Practice Address - Fax:856-691-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03870400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3192601Medicaid
NJ099664Medicare ID - Type Unspecified
NJC55384Medicare UPIN