MEDICARE: MIKE MIRON MD

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	207W00000X	Ophthalmology Physician	1706241	NY
2	207W00000X	Ophthalmology Physician	MA04779100	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	18003346	OTHER	NY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0036507	OTHER	NY	GHI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	040426012288	OTHER	NY	FIDELIS CARE
4	1053130001	OTHER	NY	DME
5	47791	OTHER	NJ	MAGNACARE
6	WS1270	OTHER	NJ	OXFORD
7	0036507	OTHER	NJ	GHI
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	00E531	OTHER	NY	EMPIRE BCBS
11	0H1451	OTHER	NY	HEALTHNET
12	0K7798	OTHER	NJ	HEALTHNET
13	WS1270	OTHER	NY	OXFORD
14	1005794	OTHER	NY	AETNA
15	16205	OTHER	NJ	AETNA
16	HIP18102	OTHER	NY	HIP

General Provider Information

NPI Number	:	1356425128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKE MIRON MD

Provider Business Mailing Address
First Line	:	40-04 KILADA COURT
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-5342
Country	:	US
Telephone Number	:	201-791-1178
Fax Number	:	201-791-6226

Provider Business Practice Location Address
First Line	:	984 N BROADWAY
Second Line	:	STE 402
City	:	YONKERS
State	:	NY
Zip	:	10701-1308
Country	:	US
Telephone Number	:	914-378-0377
Fax Number	:	914-378-0372

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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