Basic Information
| Provider Information | |||||||||
| NPI: | 1477734804 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MITSIANIS | ||||||||
| FirstName: | DIMITRA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 EUGENIO MARIA DE HOSTOS 149TH ST | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185794620 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 EUGENIO MARIA DE HOSTOS 149TH ST | ||||||||
| Address2: | DEPARTMENT OF SURGERY | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185794620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 009156 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.