Healthcare Provider Details

I. General information

NPI: 1992950240
Provider Name (Legal Business Name): MILESTONES PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2008
Last Update Date: 11/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 FRANKLIN AVE
FRANKLIN LAKES NJ
07417-1345
US

IV. Provider business mailing address

810 FRANKLIN AVE
FRANKLIN LAKES NJ
07417-1345
US

V. Phone/Fax

Practice location:
  • Phone: 201-485-7557
  • Fax: 201-485-7556
Mailing address:
  • Phone: 201-485-7557
  • Fax: 201-485-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA081739
License Number StateNJ

VIII. Authorized Official

Name: DR. LISAANN B MICHAELS
Title or Position: OWNER
Credential: MD
Phone: 201-485-7557