Provider Demographics
NPI:1548287014
Name:MITCHELL, KENNETH J (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031
Mailing Address - Country:US
Mailing Address - Phone:212-281-8800
Mailing Address - Fax:
Practice Address - Street 1:464 WEST 145TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:212-281-8800
Practice Address - Fax:212-281-8863
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003524213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T71184Medicare UPIN
NYP36741Medicare PIN