Basic Information
| Provider Information | |||||||||
| NPI: | 1356397244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOROST | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1054 | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110501054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314656297 | ||||||||
| FaxNumber: | 6314656524 | ||||||||
| Practice Location | |||||||||
| Address1: | 16303 HORACE HARDING EXPY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113651454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184544600 | ||||||||
| FaxNumber: | 7184543954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 205781 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4324H1 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | 02280835 | 05 | NY | MEDICAID |