Healthcare Provider Details

I. General information

NPI: 1770161028
Provider Name (Legal Business Name): ERIC LOUIS MISHKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERIC MISHKIN-JONES MD

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVENUE RADIOLOGY DEPT
LATHAM NY
12110
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3277
  • Fax:
Mailing address:
  • Phone: 518-782-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number343929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: