1245688019 NPI number — MR. CARLOS ANTONIO MILLER RN

Table of content: MR. CARLOS ANTONIO MILLER RN (NPI 1245688019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245688019 NPI number — MR. CARLOS ANTONIO MILLER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
CARLOS
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245688019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 MANATUCK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-1556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-216-2955
Provider Business Mailing Address Fax Number:
631-231-2389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14202 20TH AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11351-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-559-0516
Provider Business Practice Location Address Fax Number:
718-358-7502
Provider Enumeration Date:
06/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  629863-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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