Provider Demographics
NPI:1407086804
Name:MILBURN MEDICAL
Entity Type:Organization
Organization Name:MILBURN MEDICAL
Other - Org Name:MILBURN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-657-4000
Mailing Address - Street 1:17325 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5523
Mailing Address - Country:US
Mailing Address - Phone:718-657-4000
Mailing Address - Fax:718-657-6000
Practice Address - Street 1:17325 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5523
Practice Address - Country:US
Practice Address - Phone:718-657-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214330261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH3860Medicare UPIN