Provider Demographics
NPI:1518263912
Name:MILLER, OMAR FLANIGAN (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:FLANIGAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334- 51ST STREET
Mailing Address - Street 2:APT #15
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:718-869-3217
Mailing Address - Fax:
Practice Address - Street 1:334 51ST STREET
Practice Address - Street 2:APT #15
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-869-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234604-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse