Healthcare Provider Details

I. General information

NPI: 1235797358
Provider Name (Legal Business Name): MILLER PLACE NEUROLOGY AND SLEEP SPECIALTY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 ROUTE 25A STE 2
MILLER PLACE NY
11764-2648
US

IV. Provider business mailing address

595 ROUTE 25A STE 2
MILLER PLACE NY
11764-2648
US

V. Phone/Fax

Practice location:
  • Phone: 631-238-8271
  • Fax: 631-532-1908
Mailing address:
  • Phone: 631-238-8271
  • Fax: 631-532-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAHID RASHIDZADA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 631-238-8271