Provider Demographics
NPI:1992177539
Name:MITTELDORF, ASHER (MBA, ATP)
Entity Type:Individual
Prefix:
First Name:ASHER
Middle Name:
Last Name:MITTELDORF
Suffix:
Gender:M
Credentials:MBA, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-564-6225
Mailing Address - Fax:718-564-6226
Practice Address - Street 1:3507 AVE S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-564-6225
Practice Address - Fax:718-564-6226
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies