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Individual

DR. ELLIOTT ILYA MITNIK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
900 WASHINGTON RD, CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL, WEST POINT, NY 10996-1109
(646) 327-5476
Mailing address
3620 BEDFORD AVE APT C9, BROOKLYN, NY 11210-5212

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
260547 - 1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
33025F
UPIN NUMBER IS VAD000
NY
Enumeration date
09/20/2011
Last updated
09/20/2011
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