Provider Demographics
NPI:1679538334
Name:MINTZ, ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:MINTZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 IVY BROOK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6416
Mailing Address - Country:US
Mailing Address - Phone:203-372-6460
Mailing Address - Fax:203-372-6470
Practice Address - Street 1:2 IVY BROOK RD STE 210
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6416
Practice Address - Country:US
Practice Address - Phone:203-372-6460
Practice Address - Fax:203-372-6470
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029744207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD88808Medicare UPIN