Provider Demographics
NPI:1609846187
Name:MIHAILA, EMILIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILIAN
Middle Name:
Last Name:MIHAILA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16610 ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1146
Mailing Address - Country:US
Mailing Address - Phone:718-883-6562
Mailing Address - Fax:718-883-6503
Practice Address - Street 1:166-10 ARCHER AVENUE
Practice Address - Street 2:SUITE A21
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1140
Practice Address - Country:US
Practice Address - Phone:718-883-6562
Practice Address - Fax:718-883-6503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016624103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2717944Medicaid
NY2717944Medicaid