Individual
DR. NORMAN MICKENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18162 TUDOR RD, JAMAICA, NY 11432-1447
(718) 380-0939
Mailing address
18162 TUDOR RD, JAMAICA, NY 11432-1447
(718) 380-0939
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
90036
NY
Other
Enumeration date
10/28/2010
Last updated
10/28/2010
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