Healthcare Provider Details

I. General information

NPI: 1831226737
Provider Name (Legal Business Name): MITCHELL J. MUTTERPERL MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 33RD ST
BAYONNE NJ
07002-3916
US

IV. Provider business mailing address

22 MERIDIAN RD 7
EDISON NJ
08820-2848
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-0090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. ROHIT GUPTA
Title or Position: BILLER
Credential:
Phone: 732-321-1100