Provider Demographics
NPI:1033110747
Name:MILLS, CARL II (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:MILLS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 YAPHANK RD
Mailing Address - Street 2:STE 11B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-5051
Mailing Address - Fax:
Practice Address - Street 1:250 YAPHANK RD
Practice Address - Street 2:STE 11B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4800
Practice Address - Country:US
Practice Address - Phone:631-475-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129277208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCS229OtherOXFORD
NY0099094OtherGHI
NY302164OtherUS FAMILY
NY2353OtherVYTRA
NY6133141014OtherCIGNA
NY6133141004OtherHEALTHCARE PARTNERS
NY78A501OtherEMPIRE BCBS
NY1900115OtherUNITED HEALTHCARE
NY25868POtherHIP
NY4217185OtherAETNA
NY2C0278OtherHEALTHNET
NY2C0278OtherHEALTHNET
NY78A501OtherEMPIRE BCBS