=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548405202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIEANNE MILO RPA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2008
-----------------------------------------------------
Last Update Date | 03/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 E 70TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-606-1004
-----------------------------------------------------
Fax | 212-606-1739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 8TH AVE
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-455-3627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 010861
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------