Provider Demographics
NPI:1760493746
Name:MILIDANTRI, JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MILIDANTRI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16305 91ST ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3725
Mailing Address - Country:US
Mailing Address - Phone:718-845-0741
Mailing Address - Fax:718-835-1453
Practice Address - Street 1:16305 91ST ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3725
Practice Address - Country:US
Practice Address - Phone:718-845-0741
Practice Address - Fax:718-835-1453
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003866213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00874986Medicaid
T51222Medicare UPIN
NY00874986Medicaid