Healthcare Provider Details

I. General information

NPI: 1053305276
Provider Name (Legal Business Name): RAINER N MITTL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 HAMMERSLEY AVE FL 2
BRONX NY
10469-3113
US

IV. Provider business mailing address

1655 HAMMERSLEY AVE FL 2
BRONX NY
10469-3113
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5030
  • Fax:
Mailing address:
  • Phone: 212-305-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number113621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: