Elliott Ilya Mitnik, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

260547 - 1 Issued in NY

Practice address

900 Washington Rd
Credentials Office, Keller Army Community Hospital
West Point, NY 10996-1109

Phone

(646) 327-5476

NPI assigned

Sep 20, 2011

Last updated

Sep 20, 2011By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1881977528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 BEDFORD AVE APT C9",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112105212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WASHINGTON RD",
            "address_2": "CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL",
            "city": "WEST POINT",
            "state": "NY",
            "postal_code": "109961109",
            "telephone_number": "646-327-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITNIK",
        "first_name": "ELLIOTT",
        "middle_name": "ILYA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-20",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "260547 - 1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN NUMBER IS VAD000",
            "identifier": "33025F",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacquelyn Marie McCann, MS, ATC, PES, CES
• Karen McDermott, CLC
• Jillian McGovern, PHARMD
• Marguerite Mary McGuigan-Shuster, MD
• Patrick Miller
• Randall Lee Moore, CRNA
• Renee Morton
• Sergio Munoz, DDS, MS
• National Vision, Inc.
• Lindsay Newcomb

• Surgery Physician in West Point, NY
• Providers in West Point, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.