Individual
CHARLES ALLEN MITGANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
371 MERRICK RD, STE 302, ROCKVILLE CENTRE, NY 11570-5301
(516) 678-5555
(516) 678-9128
Mailing address
371 MERRICK RD, STE 302, ROCKVILLE CENTRE, NY 11570-5301
(516) 678-5555
(516) 678-9128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
127551
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00425347
—
NY
Enumeration date
06/22/2005
Last updated
06/11/2008
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