NPIMap

Individual provider Active NPI

Nathan Bernard Mitkoff, M.D.

  • Internal Medicine Physician
  • Albany, NY
National Provider Identifier
1740274604
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
176508-1 Issued in NY
Practice address
178 Washington Avenue Ext
Albany, NY 12203-5304
Phone
(518) 262-5735
Fax
(518) 262-5743
NPI assigned
Sep 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 176508-1 NY Primary

Addresses

Primary practice location

178 Washington Avenue Ext
Albany, NY 12203-5304

Mailing address

178 Washington Avenue Ext
Albany, NY 12203-5304
Phone (518) 262-5735

Other practice location 1

1 Pinnacle Pl
Albany, NY 12203-3496
Phone (518) 262-5735

Other identifiers 1

IdentifierTypeStateIssuer
01558552MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081217000196 NY Practitioner - Internal Medicine 7810059391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albany Medical College of Union University, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Select PT, OT and SLP Rehabilitation Ny, PLLCGroup PAC ID 3870986656, 261 clinicians
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695

178 Washington Ave Ext
Albany, NY 12203-5304
Phone (518) 439-8077

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
176508-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince Aug 19, 1996 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Internal Medicine CurrentSince Jun 1, 2019 Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Current Accepting new patients
Albany Medical College Internal Medicine Current Accepting new patients
Albany Medical College CurrentSince Aug 19, 1996 Accepting new patients
Albany Medical College Pediatrics Current Accepting new patients

Locations

47 New Scotland Ave
#61
Albany, NY 12208
Phone (518) 262-5791

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

178 Washington Avenue Ext
Albany, NY 12203
Phone (518) 262-5735

10 McKown Rd
Albany, NY 12203
Phone (518) 262-5735

Interoperability endpoints

  • Direct secure messaging: nmitkoff20982@albanymed.direct-ci.com

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1740274604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 WASHINGTON AVENUE EXT",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122035304",
            "telephone_number": "518-262-5735",
            "fax_number": "518-262-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 WASHINGTON AVENUE EXT",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122035304",
            "telephone_number": "518-262-5735",
            "fax_number": "518-262-5743"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Pinnacle Pl",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122033496",
            "country_code": "US",
            "telephone_number": "518-262-5735",
            "fax_number": "518-262-5743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITKOFF",
        "first_name": "NATHAN",
        "middle_name": "BERNARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "176508-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01558552",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.