Provider Demographics
NPI:1083907901
Name:JOHN T MIELE, PHD LLC
Entity Type:Organization
Organization Name:JOHN T MIELE, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-464-9639
Mailing Address - Street 1:112 DULLES DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 202 (ACAP)
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3932
Practice Address - Country:US
Practice Address - Phone:973-464-9639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03288406Medicaid
NYG300037944Medicare PIN