Provider Demographics
NPI:1972521656
Name:MITTMAN, NEAL (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:MITTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 8TH AVE
Mailing Address - Street 2:P.O. BOX 450
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7800
Mailing Address - Country:US
Mailing Address - Phone:718-369-0318
Mailing Address - Fax:718-369-0290
Practice Address - Street 1:577 PROSPECT AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6065
Practice Address - Country:US
Practice Address - Phone:718-369-0318
Practice Address - Fax:718-369-0290
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY136867207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00998334Medicaid
NY390003552OtherMEDICARE RAILROAD
B19853Medicare UPIN
NY00998334Medicaid