Healthcare Provider Details

I. General information

NPI: 1487875001
Provider Name (Legal Business Name): LAUREN MIELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 FIRST STREET WINTHROP UNIVERSITY HOSPITAL GP4
MINEOLA NY
11501
US

IV. Provider business mailing address

259 FIRST STREET WINTHROP UNIVERSITY HOSPITAL GP4
MINEOLA NY
11501
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2384
  • Fax: 516-663-8288
Mailing address:
  • Phone: 516-663-2384
  • Fax: 516-663-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number009671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: