Individual
DANIEL MIZRAHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
44 E JIMMIE LEEDS RD STE 101, GALLOWAY, NJ 08205-9599
(609) 677-9729
Mailing address
111 S 11TH ST, THOMAS JEFFERSON UNIVERSITY HOSPITAL, PHILADELPHIA, PA 19107-4824
(215) 955-6000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA10214700
NJ
390200000X
Student in an Organized Health Care Education/Training Program
MT201066
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0619523
—
NJ
01
—
678486
MEDICARE OF NJ
NJ
Enumeration date
04/25/2012
Last updated
09/10/2019
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