Provider Demographics
NPI:1912054438
Name:KEVIN MULLINS MD PC
Entity Type:Organization
Organization Name:KEVIN MULLINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-5371
Mailing Address - Street 1:1175 MONTAUK HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4939
Mailing Address - Country:US
Mailing Address - Phone:631-422-5371
Mailing Address - Fax:
Practice Address - Street 1:1175 MONTAUK HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-422-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207T00000X
207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDA9178OtherMEDICARE RR
NYWEP061Medicare ID - Type Unspecified