Provider Demographics
NPI:1699772145
Name:MITTLER, BARBARA ELLEN (DPM)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN
Last Name:MITTLER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1234
Mailing Address - Country:US
Mailing Address - Phone:845-735-9222
Mailing Address - Fax:845-735-9450
Practice Address - Street 1:96 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1234
Practice Address - Country:US
Practice Address - Phone:845-735-9222
Practice Address - Fax:845-735-9450
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2012-12-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
NYN3273213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery