Provider Demographics
NPI:1841803442
Name:ROPER, MILARD KING III (LAC LMT)
Entity Type:Individual
Prefix:MR
First Name:MILARD
Middle Name:KING
Last Name:ROPER
Suffix:III
Gender:M
Credentials:LAC LMT
Other - Prefix:MR
Other - First Name:MILARD
Other - Middle Name:
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:151 CENTERSHORE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6059
Practice Address - Country:US
Practice Address - Phone:631-327-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013153225700000X
NY002494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist