Healthcare Provider Details

I. General information

NPI: 1013980903
Provider Name (Legal Business Name): ABRAHAM MITTELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 WESTCHESTER AVE SUITE 100
PURCHASE NY
10577-2535
US

IV. Provider business mailing address

3010 WESTCHESTER AVE SUITE 100
PURCHASE NY
10577-2535
US

V. Phone/Fax

Practice location:
  • Phone: 914-701-0001
  • Fax: 914-701-0002
Mailing address:
  • Phone: 914-701-0001
  • Fax: 914-701-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number136251
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number136251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: