Healthcare Provider Details

I. General information

NPI: 1295954352
Provider Name (Legal Business Name): EUGENE PAUL MILFORD D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

IV. Provider business mailing address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-246-7417
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-246-7417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number037598-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: