Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 179311 | NY |
NPI | 1043254469 |
---|---|
Provider Name | Eric Ira Mitchnick |
First Address | Port Jefferson Station, NY 11776-2028 |
Second Address | Port Jefferson Station, NY 11776-2028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 27/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49042 | (02) | NY |