Provider Demographics
NPI:1134388259
Name:MITGANG, JOSHUA THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:THEODORE
Last Name:MITGANG
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 1:825 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2405
Mailing Address - Country:US
Mailing Address - Phone:516-569-3867
Mailing Address - Fax:
Practice Address - Street 1:123 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2240
Practice Address - Country:US
Practice Address - Phone:516-992-4566
Practice Address - Fax:516-992-4637
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254767174400000X, 207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program