Provider Demographics
NPI:1891200242
Name:MILLROD, JOSHUA MARK (LCAT, MT-BTC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
Last Name:MILLROD
Suffix:
Gender:M
Credentials:LCAT, MT-BTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 LAFAYETTE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4810
Mailing Address - Country:US
Mailing Address - Phone:646-812-8721
Mailing Address - Fax:
Practice Address - Street 1:941 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6715
Practice Address - Country:US
Practice Address - Phone:646-812-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002159225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist