Individual
EVERTON MITCHELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 BERGER AVE, SYRACUSE, NY 13205-1704
(917) 645-7990
Mailing address
118 BERGER AVE, SYRACUSE, NY 13205-1704
(917) 645-7990
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
876870981
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822836297
—
NY
Enumeration date
09/21/2017
Last updated
07/21/2022
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