Provider Demographics
NPI:1356387062
Name:MITCHELL, JAMES EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:MITCHELL
Suffix:JR
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 1:389 WASHINGTON ST APT 30J
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-8966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4924
Practice Address - Country:US
Practice Address - Phone:551-251-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11318200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD76881001OtherBLUE SHIELD
DCH9140007Medicaid
DC027068900Medicaid
MD781002400Medicaid
MD781002400Medicaid
MD76881001OtherBLUE SHIELD