Healthcare Provider Details

I. General information

NPI: 1679934343
Provider Name (Legal Business Name): MR. DEMETRIOS MILIOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 01/06/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 AMSTERDAM AVE
NEW YORK NY
10031-4611
US

IV. Provider business mailing address

EMMA BOWEN COMMUNITY CLINIC 1727 AMSTERDAM AVE
NEW YORK NY
10031
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-9200
  • Fax: 212-694-0880
Mailing address:
  • Phone: 212-694-9200
  • Fax: 212-694-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340494
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF403842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: