Provider Demographics
NPI:1154591311
Name:RAINER N MITTL OPHTHALMOLOGIST PC
Entity type:Organization
Organization Name:RAINER N MITTL OPHTHALMOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAINER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MITTL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-305-5030
Mailing Address - Street 1:1655 HAMMERSLEY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3113
Mailing Address - Country:US
Mailing Address - Phone:212-305-5030
Mailing Address - Fax:
Practice Address - Street 1:1655 HAMMERSLEY AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3113
Practice Address - Country:US
Practice Address - Phone:212-305-5030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2022-08-24
Deactivation Date:2008-03-11
Deactivation Code:
Reactivation Date:2008-04-17
Provider Licenses
StateLicense IDTaxonomies
NY113621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00206964Medicaid
NYWER771Medicare PIN
NY00206964Medicaid