Healthcare Provider Details

I. General information

NPI: 1689702987
Provider Name (Legal Business Name): DEAN MITCHELL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 I U WILLETS RD
ALBERTSON NY
11507-1516
US

IV. Provider business mailing address

67 PACIFIC ST
FRANKLIN SQUARE NY
11010-2911
US

V. Phone/Fax

Practice location:
  • Phone: 516-739-4900
  • Fax: 516-739-4909
Mailing address:
  • Phone: 516-270-3049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021572-1
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier00274415
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: