Provider Demographics
NPI:1851368138
Name:OCONNELL, MILTON J (RPA-C)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:J
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 PLATTE CLOVE ROAD
Mailing Address - Street 2:ESOPUS MEDICAL, PC
Mailing Address - City:ELKA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12427
Mailing Address - Country:US
Mailing Address - Phone:518-589-6178
Mailing Address - Fax:
Practice Address - Street 1:2255 PLATTE CLOVE RD
Practice Address - Street 2:
Practice Address - City:ELKA PARK
Practice Address - State:NY
Practice Address - Zip Code:12427-1014
Practice Address - Country:US
Practice Address - Phone:845-658-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053471363AM0700X
NY010238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02690857Medicaid
NY02690857Medicaid
NY293171OtherHMO - CHESTER
NYMO1152002OtherDEA
NYQ45024Medicare UPIN