Healthcare Provider Details

I. General information

NPI: 1891942926
Provider Name (Legal Business Name): PAUL MARIO MIGNONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 STEVENS AVE
MOUNT VERNON NY
10550-2534
US

IV. Provider business mailing address

202 STEVENS AVE
MOUNT VERNON NY
10550-2534
US

V. Phone/Fax

Practice location:
  • Phone: 914-664-6001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number249133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: