Healthcare Provider Details

I. General information

NPI: 1912382524
Provider Name (Legal Business Name): MORGANNE MILLER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 EXECUTIVE DR SUITE 500
NEW WINDSOR NY
12553-5506
US

IV. Provider business mailing address

560 WHITE PLAINS RD SUITE 615
TARRYTOWN NY
10591-5113
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-0760
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002602
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: