Provider Demographics
NPI:1295000206
Name:MIKLUCH, BEATA (RN)
Entity Type:Individual
Prefix:MS
First Name:BEATA
Middle Name:
Last Name:MIKLUCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 E 14TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1155
Mailing Address - Country:US
Mailing Address - Phone:718-375-2300
Mailing Address - Fax:888-506-2272
Practice Address - Street 1:1664 E 14TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1155
Practice Address - Country:US
Practice Address - Phone:718-375-2300
Practice Address - Fax:888-506-2272
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY644961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse