Provider Demographics
NPI:1760408330
Name:MIYAKE, CAROL (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MIYAKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:243 NORTH ROAD, SUITE 304
Mailing Address - Street 2:PREMIER MEDICAL GROUP OF THE HUDSON VALLEY, P.C.
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1364
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-451-7757
Practice Address - Street 1:1 WEBSTER AVE STE 301
Practice Address - Street 2:NEW CENTURY MEDICAL ASSOCIATES
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1364
Practice Address - Country:US
Practice Address - Phone:845-790-6100
Practice Address - Fax:845-345-9966
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-04-23
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Provider Licenses
StateLicense IDTaxonomies
NY1712931207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01800802Medicaid
A400088418Medicare PIN
NYE59344Medicare UPIN