Healthcare Provider Details

I. General information

NPI: 1720468176
Provider Name (Legal Business Name): MICHELLE Q MIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CANAL ST FL 3
NEW YORK NY
10013-4114
US

IV. Provider business mailing address

219 CANAL ST FL 3
NEW YORK NY
10013-4114
US

V. Phone/Fax

Practice location:
  • Phone: 646-476-3021
  • Fax:
Mailing address:
  • Phone: 646-476-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number008841
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: