Physician Compare National (NPI:1821166877)

HEALTHCARE PROVIDER: ROBERT JAY MITTMAN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1821166877
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183882004
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120223000752
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MITTMAN
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ALLERGY/IMMUNOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ALLERGY/IMMUNOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	3821 BELL BLVD
	Group Practice or individual's line 1 address
City	BAYSIDE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113612058
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7184239300
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y