Healthcare Provider Details

I. General information

NPI: 1356405252
Provider Name (Legal Business Name): AYELET MIZRACHI-JONISCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEDFORD RD
KATONAH NY
10536-2115
US

IV. Provider business mailing address

111 BEDFORD RD
KATONAH NY
10536-2115
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-3135
  • Fax: 914-232-1169
Mailing address:
  • Phone: 914-232-3135
  • Fax: 914-232-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number240203
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number044387
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: