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General NPI Number Information
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NPI Number | 1679242002
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Entity Type | Organization
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Legal Business Name | THE MIA CENTER LLC
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 12 PLATINUM CT STE C
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City | MEDFORD
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State | NY
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Zip | 11763-2247
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Country | US
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Telephone | 631-996-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 12 PLATINUM CT STE C
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City | MEDFORD
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State | NY
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Zip | 11763-2247
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Country | US
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Telephone | 631-996-4430
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREN CONSTANCE FIELD
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Credential | PNP
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Telephone | 631-996-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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