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General NPI Number Information
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NPI Number | 1659921716
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Entity Type | Organization
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Legal Business Name | MILLENIUM MEDICAL PRODUCTS, INC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 204 19 12TH AVE
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City | ROCKAWAY POINT
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State | NY
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Zip | 11697-1120
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Country | US
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Telephone | 917-363-3460
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Fax | 347-246-7489
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Provider Business Mailing Address
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Address Line | 204 19 12TH AVE
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City | ROCKAWAY POINT
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State | NY
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Zip | 11697-1120
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Country | US
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Telephone | 917-363-3460
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Fax | 347-246-7489
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. EDWARD FLANAGAN
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Credential |
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Telephone | 917-363-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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