MEDICARE: MIRANDA M LE

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	174400000X	Specialist	2516291	NY

General Provider Information

NPI Number	:	1710249164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA M LE

Provider Business Mailing Address
First Line	:	474 48TH AVE APT 37D
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11109-5626
Country	:	US
Telephone Number	:	347-301-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 W 37TH ST RM 880
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-4273
Country	:	US
Telephone Number	:	218-234-2687
Fax Number	:

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	07/07/2020

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Directions to “ MIRANDA M LE ” Practice Location

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