MEDICARE: PATIENT BRIDGE HEALTH MEDICAL GROUP, P.A.

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1609727536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT BRIDGE HEALTH MEDICAL GROUP, P.A.

Provider Business Mailing Address
First Line	:	21212 NORTHERN BLVD FL 3
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3388
Country	:	US
Telephone Number	:	917-847-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	21212 NORTHERN BLVD FL 3
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3388
Country	:	US
Telephone Number	:	917-847-0810
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILLIP A MITCHELL
Credential	:
Telephone Number	:	917-847-0810

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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