Provider Demographics
NPI:1710024823
Name:MIU K MA MD PLLC
Entity Type:Organization
Organization Name:MIU K MA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIU
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-732-2638
Mailing Address - Street 1:128 MOTT ST
Mailing Address - Street 2:#603
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5540
Mailing Address - Country:US
Mailing Address - Phone:212-732-2638
Mailing Address - Fax:212-732-1029
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:#603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-732-2638
Practice Address - Fax:212-732-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty