Healthcare Provider Details

I. General information

NPI: 1699688606
Provider Name (Legal Business Name): MICAELA MILLAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 COOPER AVE
GLENDALE NY
11385-7725
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD FL 4
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 718-725-7970
  • Fax:
Mailing address:
  • Phone: 516-474-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: