Provider Demographics
NPI:1558882522
Name:BIJU, MILI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MILI
Middle Name:
Last Name:BIJU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MILIMOLE
Other - Middle Name:
Other - Last Name:SUKUMARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:400H HORSEBLOCK ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738
Mailing Address - Country:US
Mailing Address - Phone:631-451-2211
Mailing Address - Fax:631-451-1463
Practice Address - Street 1:400H HORSEBLOCK ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738
Practice Address - Country:US
Practice Address - Phone:631-451-2211
Practice Address - Fax:631-451-1463
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY572244163W00000X
NY341614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse