Provider Demographics
NPI:1912975582
Name:MINTZ, MILTON J (DO)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:J
Last Name:MINTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-3714
Mailing Address - Country:US
Mailing Address - Phone:973-216-4009
Mailing Address - Fax:973-625-0721
Practice Address - Street 1:13 MICHAEL CT
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3714
Practice Address - Country:US
Practice Address - Phone:973-216-4009
Practice Address - Fax:973-625-0721
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB15263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00079359OtherRAILROAD MEDICARE
NJP00079359OtherRAILROAD MEDICARE
NJE06147Medicare UPIN