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NPI Code Detail

MEDICARE: KIMBERLY MILAGROS MITMA

MEDICARE: KIMBERLY MILAGROS MITMA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1356285563
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MILAGROS MITMA
Provider Business Mailing Address
First Line : 225 BROADHOLLOW RD STE 402
Second Line :
City : MELVILLE
State : NY
Zip : 11747-4899
Country : US
Telephone Number : 631-385-7780
Fax Number :
Provider Business Practice Location Address
First Line : 424 CENTRAL AVE STE 2
Second Line :
City : WESTFIELD
State : NJ
Zip : 07090-2561
Country : US
Telephone Number : 908-588-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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Directions to “ KIMBERLY MILAGROS MITMA ” Practice Location

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