Provider Demographics
NPI:1013980903
Name:MITTELMAN, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:MITTELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2535
Mailing Address - Country:US
Mailing Address - Phone:914-701-0001
Mailing Address - Fax:914-701-0002
Practice Address - Street 1:3010 WESTCHESTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2535
Practice Address - Country:US
Practice Address - Phone:914-701-0001
Practice Address - Fax:914-701-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136251173000000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA96080Medicare UPIN
W8H411Medicare ID - Type Unspecified