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General NPI Number Information
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NPI Number | 1396854089
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Entity Type | Organization
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Legal Business Name | MISHKIN MILLER FORMAN PC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 238-25 HILLSIDE AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-1329
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Country | US
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Telephone | 718-464-7376
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Fax | 718-464-0301
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Provider Business Mailing Address
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Address Line | 238-25 HILLSIDE AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-1329
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Country | US
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Telephone | 718-464-7376
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Fax | 718-464-0301
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. PAUL J MILLER
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Credential | MD
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Telephone | 718-464-7376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 082626
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 072785
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License Number State | NY
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