Healthcare Provider Details

I. General information

NPI: 1356733612
Provider Name (Legal Business Name): YAROSLAVA MILOV PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BERME RD
NAPANOCH NY
12458-2709
US

IV. Provider business mailing address

750 BERME RD
NAPANOCH NY
12458-2709
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-1670
  • Fax:
Mailing address:
  • Phone: 845-647-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: