MEDICARE: ABRAHAM MINTZ MD PC

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	207T00000X	Neurological Surgery Physician	029744	CT

General Provider Information

NPI Number	:	1427246297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABRAHAM MINTZ MD PC

Provider Business Mailing Address
First Line	:	2 IVY BROOK RD STE 210
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-372-6460
Fax Number	:	203-372-6470

Provider Business Practice Location Address
First Line	:	2 IVY BROOK RD STE 210
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-372-6460
Fax Number	:	203-372-6470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABRAHAM MINTZ
Credential	:	M.D.
Telephone Number	:	203-372-6460

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	07/21/2022

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