Healthcare Provider Details

I. General information

NPI: 1215291240
Provider Name (Legal Business Name): ERIC MITTELMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD STE 506
PARAMUS NJ
07652-3517
US

IV. Provider business mailing address

260 OLD HOOK RD SUITE 200
WESTWOOD NJ
07675-3123
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8100
  • Fax: 551-996-4140
Mailing address:
  • Phone: 201-967-8425
  • Fax: 201-263-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09935300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: