Provider Demographics
NPI:1003272766
Name:MILLER, NOEL K
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:K
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPS; MBA;LMSW
Mailing Address - Street 1:2415 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3538
Mailing Address - Country:US
Mailing Address - Phone:718-863-4100
Mailing Address - Fax:718-863-5165
Practice Address - Street 1:2415 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3538
Practice Address - Country:US
Practice Address - Phone:718-863-4100
Practice Address - Fax:718-863-5165
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072575-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6313OtherPIBLY RESIDENTIAL PROGRAMS