Basic Information
| Provider Information | |||||||||
| NPI: | 1104571892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILEA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ALYSSA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 HINSDALE AVE | ||||||||
| Address2: | |||||||||
| City: | FLORAL PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110011503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165892895 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270-05 76TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110401402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2022 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.