Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 283517 | NY |
NPI | 1124469069 |
---|---|
Provider Name | Mike Mizrahi |
First Address | New York, NY 10065-4870 |
Second Address | New York, NY 10065-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2013 |
Last Update Date | 17/03/2018 |