Provider Demographics
NPI:1336217827
Name:CASSEL, MITCHELL (OD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:CASSEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 WEST 49TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020
Practice Address - Country:US
Practice Address - Phone:212-765-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUT004231-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
645061OtherUNITED
471822OtherAETNA
9653152OtherGHI
NYC362410OtherBCBS
3C5493OtherHEALTHNET
2493288OtherCIGNA
645061OtherOXFORD
U54361Medicare UPIN
NYC36241Medicare ID - Type Unspecified
2493288OtherCIGNA