Provider Demographics
NPI:1770810970
Name:WALTER MIZELL INCORPORATE
Entity type:Organization
Organization Name:WALTER MIZELL INCORPORATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-245-3279
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:646-245-3279
Mailing Address - Fax:
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:646-245-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty