Provider Demographics
NPI:1700229796
Name:HAMILTON, MILLICENT (NP)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3108
Mailing Address - Country:US
Mailing Address - Phone:212-876-2300
Mailing Address - Fax:212-369-8209
Practice Address - Street 1:332 ROGERS AVE
Practice Address - Street 2:APT. D11
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2951
Practice Address - Country:US
Practice Address - Phone:347-647-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305355363LA2200X
NYF305355363LA2200X
NYF402488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty