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Individual

MR. DEAN CORY MITCHELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
57 W 57TH ST STE 601, NEW YORK, NY 10019-2802
(212) 397-0157
(212) 586-6880
Mailing address
165 NORTH VIALLGE AVENUE, SUITE #129, ROCKVILLE CENTRE, NY 11570
(516) 678-9600
(516) 678-9618

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
170802
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
261707718
TAX IDENTIFICATION NUMBER
NY
Enumeration date
01/16/2007
Last updated
04/12/2012
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