Provider Demographics
NPI:1750697819
Name:MITZO, HARRY JOSEPH JR
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:JOSEPH
Last Name:MITZO
Suffix:JR
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 1:305 ADAN AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7614
Mailing Address - Country:US
Mailing Address - Phone:888-788-1906
Mailing Address - Fax:
Practice Address - Street 1:305 ADAN AVE SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-7614
Practice Address - Country:US
Practice Address - Phone:888-788-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100283171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor