Individual
MAXWELL JACOB MITTELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 FIRST ST NE, 9TH FLOOR, WASHINGTON, DC 20002
(202) 442-5885
Mailing address
1200 1ST ST NE FL 9, WASHINGTON, DC 20002-7953
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YKZ3HZN31681870
HORIZON BLUE CROSS BLUE SHIELD OMNIA SILVER HSA
NJ
Enumeration date
07/07/2017
Last updated
07/07/2017
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