Healthcare Provider Details

I. General information

NPI: 1811939465
Provider Name (Legal Business Name): NIRANJAN K MITTAL, PHYSICIAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 5TH AVE
BROOKLYN NY
11209-2704
US

IV. Provider business mailing address

7404 5TH AVENUE
BROOKLYN NY
11209-2704
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5111
  • Fax: 866-790-3506
Mailing address:
  • Phone: 718-439-5111
  • Fax: 866-790-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number162509
License Number StateNY

VIII. Authorized Official

Name: NIRANJAN KUMAR MITTAL
Title or Position: OWNER
Credential: MD
Phone: 718-439-5111