Provider Demographics
NPI:1013999697
Name:SEIDMAN, MITCHELL STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:STEVEN
Last Name:SEIDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2989 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8386
Mailing Address - Country:US
Mailing Address - Phone:718-332-2020
Mailing Address - Fax:718-332-3248
Practice Address - Street 1:2989 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8386
Practice Address - Country:US
Practice Address - Phone:718-332-2020
Practice Address - Fax:718-332-3248
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135268207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400023557OtherMEDICARE PTAN
NY00434753Medicaid