Healthcare Provider Details

I. General information

NPI: 1568993012
Provider Name (Legal Business Name): JOSEPH MIZRAHI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

281 1ST AVE FL HALL17
NEW YORK NY
10003-2925
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4015
  • Fax: 212-844-6332
Mailing address:
  • Phone: 212-420-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number307335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: