Provider Demographics
NPI:1023467792
Name:MIZELL, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MIZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE
Mailing Address - Street 2:59TH. FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-0110
Mailing Address - Country:US
Mailing Address - Phone:800-473-7746
Mailing Address - Fax:516-441-3584
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:59TH. FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118-0110
Practice Address - Country:US
Practice Address - Phone:800-473-7746
Practice Address - Fax:516-441-3584
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic