Provider Demographics
NPI:1871961029
Name:MITTEL, CHANA
Entity type:Individual
Prefix:
First Name:CHANA
Middle Name:
Last Name:MITTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1211
Mailing Address - Country:US
Mailing Address - Phone:973-778-6386
Mailing Address - Fax:
Practice Address - Street 1:541 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1211
Practice Address - Country:US
Practice Address - Phone:973-778-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist