1376514109 NPI number — MRS. JENNIFER Y MILANO MA CCCA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376514109 NPI number — MRS. JENNIFER Y MILANO MA CCCA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MILANO

Provider First Name:

JENNIFER

Provider Middle Name:

Y

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

MA CCCA

Provider Gender Code:

F

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:

1376514109

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/14/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

290 CENTRAL AVE

Provider Second Line Business Mailing Address:

STE 116

Provider Business Mailing Address City Name:

LAWRENCE

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11559-8507

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

516-239-6400

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

672 NORTH WELLWOOD AVE

Provider Second Line Business Practice Location Address:

STE #1

Provider Business Practice Location Address City Name:

LINDENHURST

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11757

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

631-956-3277

Provider Business Practice Location Address Fax Number:

631-956-3279

Provider Enumeration Date:

01/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 237600000X , with the licence number:  001610 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 231H00000X , with the licence number: 001610 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 050550321 . This is a "HORIZON" identifier . This identifiers is of the category "OTHER".
• Identifier: 05055032101 . This is a "1199" identifier . This identifiers is of the category "OTHER".
• Identifier: 4899794 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: P2103432 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 050550321 . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
• Identifier: M72201 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
• Identifier: 050550321 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
• Identifier: 3C9136 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: P00257003 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
• Identifier: 390133 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: D50550321 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 1095677 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 19861P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 55032ILIN . This is a "UHC" identifier . This identifiers is of the category "OTHER".