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NPI Code Detail

MEDICARE: MIOK IM

MEDICARE: MIOK IM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner338174NY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner405461NY

General Provider Information

NPI Number : 1265873293
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIOK IM
Provider Business Mailing Address
First Line : 4332 22ND ST STE 203
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5077
Country : US
Telephone Number : 551-395-7952
Fax Number : 620-877-9147
Provider Business Practice Location Address
First Line : 4332 22ND ST STE 203
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-5077
Country : US
Telephone Number : 551-395-7952
Fax Number : 620-877-9147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2013
Last Update Date : 01/21/2026

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Directions to “ MIOK IM ” Practice Location

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