Provider Demographics
NPI:1851345102
Name:MIRANDA, ANNIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:L
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1989 ROUTE 52
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3533
Mailing Address - Country:US
Mailing Address - Phone:845-897-4500
Mailing Address - Fax:845-897-4550
Practice Address - Street 1:1989 ROUTE 52
Practice Address - Street 2:SUITE 3
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3533
Practice Address - Country:US
Practice Address - Phone:845-897-4500
Practice Address - Fax:845-897-4550
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2101852080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990692Medicaid
NY7B-9821Medicare ID - Type UnspecifiedPHYSICIAN ID CODE
NYI-53186Medicare UPIN