Healthcare Provider Details

I. General information

NPI: 1003088964
Provider Name (Legal Business Name): MR. ROBERT JOSEPH MIELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 SAINT MARKS PL
NEW YORK NY
10003-7902
US

IV. Provider business mailing address

6407 FOREST AVE 1R
RIDGEWOOD NY
11385-2534
US

V. Phone/Fax

Practice location:
  • Phone: 212-982-3470
  • Fax: 212-477-0521
Mailing address:
  • Phone: 917-250-4354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNA
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: