Provider Demographics
NPI:1538126347
Name:MIERLAK, JULIAN A (MD, MS)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:A
Last Name:MIERLAK
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FIRST AVE
Mailing Address - Street 2:NBV 9E2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1101
Mailing Address - Country:US
Mailing Address - Phone:212-263-5143
Mailing Address - Fax:212-263-8887
Practice Address - Street 1:550 FIRST AVE
Practice Address - Street 2:NBV 9E2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1101
Practice Address - Country:US
Practice Address - Phone:212-263-5143
Practice Address - Fax:212-263-8887
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138709207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01696148Medicaid
NY70A7311Medicare ID - Type Unspecified
NY01696148Medicaid