Provider Demographics
NPI:1326258997
Name:MILLENNIUM MEDICAL HEALTHCARE GROUP PLLC
Entity Type:Organization
Organization Name:MILLENNIUM MEDICAL HEALTHCARE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-294-7690
Mailing Address - Street 1:137-72 NORTHERN BLVD.
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11357
Mailing Address - Country:US
Mailing Address - Phone:516-294-7690
Mailing Address - Fax:516-294-7672
Practice Address - Street 1:137-72 NORTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:516-294-7690
Practice Address - Fax:516-294-7672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty