MEDICARE: DR. ABINASH MISHRA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P11719	NY

General Provider Information

NPI Number	:	1063999183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABINASH MISHRA DPM

Provider Business Mailing Address
First Line	:	1360 NEW YORK AVE APT 6F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-6236
Country	:	US
Telephone Number	:	305-331-4416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 NEW YORK AVE APT 6F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-6236
Country	:	US
Telephone Number	:	305-331-4416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2018
Last Update Date	:	07/21/2018

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