Healthcare Provider Details

I. General information

NPI: 1063486116
Provider Name (Legal Business Name): PATRICK MIZRAHI
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PARK AVE
NEW YORK NY
10028-0208
US

IV. Provider business mailing address

5 EAST 86TH STREET GROUND FLOOR
NEW YORK NY
10028-0538
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-4466
  • Fax:
Mailing address:
  • Phone: 212-737-4466
  • Fax: 212-737-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number203611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: