Provider Demographics
NPI:1043284193
Name:PATRICK V. MIZRAHI M.D., P.C.
Entity type:Organization
Organization Name:PATRICK V. MIZRAHI M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:V
Authorized Official - Last Name:MIZRAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-737-4466
Mailing Address - Street 1:173 E BROADWAY
Mailing Address - Street 2:APT 6-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5548
Mailing Address - Country:US
Mailing Address - Phone:212-737-4466
Mailing Address - Fax:
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0208
Practice Address - Country:US
Practice Address - Phone:212-737-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203611173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG16745Medicare UPIN
NYWDP611Medicare ID - Type Unspecified