Provider Demographics
NPI:1679934343
Name:MILIOS, DEMETRIOS
Entity Type:Individual
Prefix:MR
First Name:DEMETRIOS
Middle Name:
Last Name:MILIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 BAY PKWY
Mailing Address - Street 2:STE 901
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6081
Mailing Address - Country:US
Mailing Address - Phone:718-238-2100
Mailing Address - Fax:718-475-1821
Practice Address - Street 1:6010 BAY PKWY
Practice Address - Street 2:STE 901
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6081
Practice Address - Country:US
Practice Address - Phone:718-238-2100
Practice Address - Fax:718-475-1821
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily