Provider Demographics
NPI:1356397244
Name:CHOROST, MITCHELL I (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:I
Last Name:CHOROST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1054
Mailing Address - Country:US
Mailing Address - Phone:631-465-6297
Mailing Address - Fax:631-465-6524
Practice Address - Street 1:16303 HORACE HARDING EXPY
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1454
Practice Address - Country:US
Practice Address - Phone:718-454-4600
Practice Address - Fax:718-454-3954
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2014-06-30
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Provider Licenses
StateLicense IDTaxonomies
NY2057812086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4324H1OtherBLUE CROSS BLUE SHIELD
NY02280835Medicaid
NYG400008132Medicare PIN