Provider Demographics
NPI:1255476404
Name:MILDER, EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:MILDER
Suffix:
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 1:180 OCEAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2408
Mailing Address - Country:US
Mailing Address - Phone:718-853-6300
Mailing Address - Fax:
Practice Address - Street 1:180 OCEAN PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2408
Practice Address - Country:US
Practice Address - Phone:718-853-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078179207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10677Medicare UPIN
NY18842Medicare ID - Type Unspecified