Doctor Name: | JUDY MITTLEMAN |
NPI Number: | 1306810866 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 206015 |
Business Practice Address: | 2500 Marcus Ave Suite 105 Lake Success, NY - 110421018 |
Business Phone Number: | 5163581200 |
Business Fax Number: | 5163582340 |
Mailing Address: | 2500 Marcus Ave, Suite 105 LAKE SUCCESS |
State: | NY |
Postal Code: | 110421018 |
Phone Number: | 5163581200 |
Fax Number: | 5163582340 |
NPI Enumeration Date: | 02/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 206015 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |