MEDICARE: JULIAN A MIERLAK MD, MS

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	207V00000X	Obstetrics & Gynecology Physician	138709	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538126347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN A MIERLAK MD, MS

Provider Business Mailing Address
First Line	:	550 FIRST AVE
Second Line	:	NBV 9E2
City	:	NEW YORK
State	:	NY
Zip	:	10016-1101
Country	:	US
Telephone Number	:	212-263-5143
Fax Number	:	212-263-8887

Provider Business Practice Location Address
First Line	:	550 FIRST AVE
Second Line	:	NBV 9E2
City	:	NEW YORK
State	:	NY
Zip	:	10016-1101
Country	:	US
Telephone Number	:	212-263-5143
Fax Number	:	212-263-8887

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	10/18/2010

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