Mitchell Gary Proffman, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

X2684 Issued in NY

Practice address

14402 69TH Ave
Flushing, NY 11367-1710

Phone

(718) 268-9080

Fax

(718) 544-2381

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649326661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14402 69TH AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671710",
            "telephone_number": "718-268-9080",
            "fax_number": "718-544-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14402 69TH AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671710",
            "telephone_number": "718-268-9080",
            "fax_number": "718-544-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFFMAN",
        "first_name": "MITCHELL",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X2684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Physician Chiropractor in Flushing, NY
• Providers in Flushing, NY by specialty
• Sports Physician Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.