Provider Demographics
NPI:1831219732
Name:GINSBURG, MITCHELL HARRIS
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:HARRIS
Last Name:GINSBURG
Suffix:
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 1:1207 E GRAND ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2319
Mailing Address - Country:US
Mailing Address - Phone:908-354-6868
Mailing Address - Fax:908-354-2359
Practice Address - Street 1:1207 E GRAND ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2319
Practice Address - Country:US
Practice Address - Phone:908-354-6868
Practice Address - Fax:908-354-2359
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00008600237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3090400Medicaid