MEDICARE: DR. MITCHELL STEVEN SEIDMAN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	135268	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400023557	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013999697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL STEVEN SEIDMAN DO

Provider Business Mailing Address
First Line	:	2989 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8386
Country	:	US
Telephone Number	:	718-332-2020
Fax Number	:	718-332-3248

Provider Business Practice Location Address
First Line	:	2989 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8386
Country	:	US
Telephone Number	:	718-332-2020
Fax Number	:	718-332-3248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	04/26/2010

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