MEDICARE: DR. MIRO LATI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	284309	NY

General Provider Information

NPI Number	:	1154776367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRO LATI D.O.

Provider Business Mailing Address
First Line	:	6903 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1509
Country	:	US
Telephone Number	:	718-238-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1923
Country	:	US
Telephone Number	:	718-238-6161
Fax Number	:	718-238-6194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	08/28/2025

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Directions to “ DR. MIRO LATI D.O.” Practice Location

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