Provider Demographics
NPI:1891180212
Name:FABIOLA MILORD, DDS, MPH, PLLC
Entity Type:Organization
Organization Name:FABIOLA MILORD, DDS, MPH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:516-216-5656
Mailing Address - Street 1:11201 QUEENS BLVD
Mailing Address - Street 2:UNIT 6F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5566
Mailing Address - Country:US
Mailing Address - Phone:516-216-5656
Mailing Address - Fax:
Practice Address - Street 1:1300 UNION TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1764
Practice Address - Country:US
Practice Address - Phone:516-216-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045702305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02989586Medicaid