Provider Demographics
NPI:1154561033
Name:DAVID S MITCHELL DO PA
Entity type:Organization
Organization Name:DAVID S MITCHELL DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-905-8333
Mailing Address - Street 1:1255 ROUTE 70 STE 20N
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6192
Mailing Address - Country:US
Mailing Address - Phone:732-905-8333
Mailing Address - Fax:732-905-8709
Practice Address - Street 1:1255 ROUTE 70 STE 20N
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6192
Practice Address - Country:US
Practice Address - Phone:732-905-8333
Practice Address - Fax:732-905-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB55269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ145122Medicare PIN
NJE54728Medicare UPIN