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NPI Code Detail

MEDICARE: MRS. TAHISHA MONEE MITCHELL MSED

MEDICARE: MRS. TAHISHA MONEE MITCHELL MSED
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
1174400000XSpecialistNY

General Provider Information

NPI Number : 1326292855
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAHISHA MONEE MITCHELL MSED
Provider Business Mailing Address
First Line : 165 UNION PL
Second Line :
City : RIDGEFIELD PARK
State : NJ
Zip : 07660-1234
Country : US
Telephone Number : 201-641-2737
Fax Number :
Provider Business Practice Location Address
First Line : 4302 NEW UTRECHT AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1831
Country : US
Telephone Number : 623-256-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2008
Last Update Date : 06/11/2012

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