Provider Demographics
NPI:1396854089
Name:MISHKIN MILLER FORMAN PC
Entity Type:Organization
Organization Name:MISHKIN MILLER FORMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-464-7376
Mailing Address - Street 1:238-25 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1329
Mailing Address - Country:US
Mailing Address - Phone:718-464-7376
Mailing Address - Fax:718-464-0301
Practice Address - Street 1:238-25 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1329
Practice Address - Country:US
Practice Address - Phone:718-464-7376
Practice Address - Fax:718-464-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072785207X00000X
NY082626207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00094642Medicaid
NYB021513Medicaid
NY00094642Medicaid
D03944Medicare UPIN
NY24672Medicare ID - Type UnspecifiedFORMAN
NYB021513Medicaid