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General NPI Number Information
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NPI Number | 1679870083
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Entity Type | Organization
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Legal Business Name | MIKE MIRON, M.D.,P.C.
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Dates
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Enumeration Date | 02/21/2011
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 40-04 KILADA CT
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City | FAIR LAWN
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State | NJ
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Zip | 07410-5342
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Country | US
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Telephone | 201-791-1178
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Fax | 201-791-6226
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Provider Business Mailing Address
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Address Line | 40-04 KILADA CT
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City | FAIR LAWN
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State | NJ
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Zip | 07410-5342
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Country | US
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Telephone | 201-791-1178
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Fax | 201-791-6226
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIKE MIRON
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Credential | M.D.
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Telephone | 201-791-1178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA04779200
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License Number State | NJ
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