MEDICARE: DEVORAH MINTZ 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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1427793645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVORAH MINTZ MSED

Provider Business Mailing Address
First Line	:	1651 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5849
Country	:	US
Telephone Number	:	347-668-9640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2940
Country	:	US
Telephone Number	:	718-954-3300
Fax Number	:

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

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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Directions to “ DEVORAH MINTZ MSED” Practice Location

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