Provider Demographics
NPI:1265423446
Name:MITTY, HAROLD (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:MITTY
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:ONE GUSTAVE LEVY PLACE
Mailing Address - Street 2:SUITE 1234
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029
Mailing Address - Country:US
Mailing Address - Phone:212-241-6381
Mailing Address - Fax:212-410-1973
Practice Address - Street 1:ONE GUSTAVE LEVY PLACE
Practice Address - Street 2:SUITE 1234
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-241-6381
Practice Address - Fax:212-410-1973
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0826022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00390161Medicaid
NY00390161Medicaid
NYB14655Medicare UPIN