Provider Demographics
NPI:1528151925
Name:MUTONE, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:MUTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10802-0366
Mailing Address - Country:US
Mailing Address - Phone:718-792-4500
Mailing Address - Fax:718-792-4502
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE 2-5
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-235-8911
Practice Address - Fax:914-235-1382
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01493594Medicaid
NY20I361Medicare ID - Type UnspecifiedMEDICARE