Healthcare Provider Details

I. General information

NPI: 1740366541
Provider Name (Legal Business Name): MYLES S KOBREN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S OYSTER BAY RD SUITE 301
HICKSVILLE NY
11801-3500
US

IV. Provider business mailing address

400 S OYSTER BAY RD SUITE 301
HICKSVILLE NY
11801-3500
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-8527
  • Fax: 516-933-3838
Mailing address:
  • Phone: 516-933-8527
  • Fax: 516-933-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1744861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: