Provider Demographics
NPI:1164846143
Name:MIRZA, MICHELLE LEE NEVILLE
Entity Type:Individual
Prefix:
First Name:MICHELLE LEE
Middle Name:NEVILLE
Last Name:MIRZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COVE CT
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2238
Mailing Address - Country:US
Mailing Address - Phone:201-951-6164
Mailing Address - Fax:
Practice Address - Street 1:2 COVE CT
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2238
Practice Address - Country:US
Practice Address - Phone:201-951-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program