1356425128 NPI number — MIKE MIRON MD

Table of content: MIKE MIRON MD (NPI 1356425128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356425128 NPI number — MIKE MIRON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRON
Provider First Name:
MIKE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRON
Provider Other First Name:
MIHNEA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356425128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40-04 KILADA COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-5342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-791-1178
Provider Business Mailing Address Fax Number:
201-791-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
984 N BROADWAY
Provider Second Line Business Practice Location Address:
STE 402
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-378-0377
Provider Business Practice Location Address Fax Number:
914-378-0372
Provider Enumeration Date:
10/25/2006

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: 207W00000X , with the licence number:  1706241 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: MA04779100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0036507 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01026195 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040426012288 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1053130001 . This is a "DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 47791 . This is a "MAGNACARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: WS1270 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0036507 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 18003346 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1974807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00E531 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0H1451 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0K7798 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: WS1270 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1005794 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16205 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HIP18102 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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