MEDICARE: MITCHELL S. SEIDMAN, PROFESSIONAL CORPORATION

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	207W00000X	Ophthalmology Physician	135268	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A100023556	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	135268	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1508197062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL S. SEIDMAN, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2989 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8386
Country	:	US
Telephone Number	:	718-332-2020
Fax Number	:	718-332-3248

Provider Business Practice Location Address
First Line	:	2989 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8386
Country	:	US
Telephone Number	:	718-332-2020
Fax Number	:	718-332-3248

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL STEVEN SEIDMAN
Credential	:	D.O.
Telephone Number	:	718-332-2020

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	04/26/2010

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Directions to “MITCHELL S. SEIDMAN, PROFESSIONAL CORPORATION ” Practice Location

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