Provider Demographics
NPI:1659617991
Name:PARK-COLEMAN, MILEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MILEE
Middle Name:
Last Name:PARK-COLEMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 71ST RD
Mailing Address - Street 2:#5G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4951
Mailing Address - Country:US
Mailing Address - Phone:718-544-7495
Mailing Address - Fax:
Practice Address - Street 1:11015 71ST RD
Practice Address - Street 2:#5G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4951
Practice Address - Country:US
Practice Address - Phone:718-544-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00089200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist