Provider Demographics
NPI:1386769602
Name:MITTLEMAN, IRA B (DC)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:B
Last Name:MITTLEMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 LANDAU AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1034
Mailing Address - Country:US
Mailing Address - Phone:516-488-4044
Mailing Address - Fax:516-488-4044
Practice Address - Street 1:181 LANDAU AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1034
Practice Address - Country:US
Practice Address - Phone:516-488-4044
Practice Address - Fax:516-488-4044
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX68161Medicare ID - Type UnspecifiedCHIROPRACTOR