=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750697074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILLIE R FELL MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2010
-----------------------------------------------------
Last Update Date | 12/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2025 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-339-6868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2025 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-339-6868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MILLIE R. FELL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-339-6868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------