Provider Demographics
NPI:1720193196
Name:MILLAN, FRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:MILLAN
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 1:333 W 57TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3159
Mailing Address - Country:US
Mailing Address - Phone:212-541-8869
Mailing Address - Fax:718-224-9786
Practice Address - Street 1:333 W 57TH ST
Practice Address - Street 2:STE 103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3159
Practice Address - Country:US
Practice Address - Phone:212-541-8869
Practice Address - Fax:718-224-9786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107821103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5B941Medicare ID - Type Unspecified
NYP748774Medicare UPIN
NY144802Medicare UPIN
NY6801444Medicare UPIN