Healthcare Provider Details

I. General information

NPI: 1023467792
Provider Name (Legal Business Name): ROBERT MIZELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 5TH AVE 59TH. FLOOR
NEW YORK NY
10118-0110
US

IV. Provider business mailing address

350 5TH AVE 59TH. FLOOR
NEW YORK NY
10118-0110
US

V. Phone/Fax

Practice location:
  • Phone: 800-473-7746
  • Fax: 516-441-3584
Mailing address:
  • Phone: 800-473-7746
  • Fax: 516-441-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: