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General NPI Number Information
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NPI Number | 1316499742
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Entity Type | Organization
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Legal Business Name | MILENIA IPA LLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 945 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598-1733
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Country | US
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Telephone | 516-537-4913
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Fax | 516-537-4910
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Provider Business Mailing Address
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Address Line | 945 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598-1733
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Country | US
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Telephone | 516-537-4913
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Fax | 516-537-4910
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BENT PHILIPSON
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Credential |
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Telephone | 516-537-4913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | NY
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