Provider Demographics
NPI:1417999798
Name:MILLOS, ROSANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:MILLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3952
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:26 FIREMANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3553
Practice Address - Country:US
Practice Address - Phone:845-354-0011
Practice Address - Fax:845-354-0147
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02682846Medicaid
NYH39473Medicare UPIN
NY113SC1Medicare ID - Type Unspecified