Provider Demographics
NPI:1841215746
Name:MITTLEMAN, MYLES (MD)
Entity type:Individual
Prefix:DR
First Name:MYLES
Middle Name:
Last Name:MITTLEMAN
Suffix:
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 1:5847 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1601
Mailing Address - Country:US
Mailing Address - Phone:718-225-5400
Mailing Address - Fax:718-225-6527
Practice Address - Street 1:5847 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1601
Practice Address - Country:US
Practice Address - Phone:718-225-5400
Practice Address - Fax:718-225-6527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00479603Medicaid
NY20460BMedicare ID - Type Unspecified
NY00479603Medicaid