Healthcare Provider Details

I. General information

NPI: 1922172733
Provider Name (Legal Business Name): ROBERT A MIELE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 EDISON ST
STATEN ISLAND NY
10306-3041
US

IV. Provider business mailing address

850 HOWARD AVENUE APT 6H
STATEN ISLAND NY
10301
US

V. Phone/Fax

Practice location:
  • Phone: 718-524-4112
  • Fax: 718-524-4189
Mailing address:
  • Phone: 718-981-6070
  • Fax: 718-447-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN002674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: