Healthcare Provider Details

I. General information

NPI: 1811573538
Provider Name (Legal Business Name): MITCHELL HILLEL DITTUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W PARK AVE STE 213
OCEAN NJ
07712-8526
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 732-695-2555
  • Fax: 732-695-2552
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA13210700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: