Provider Demographics
NPI:1336611656
Name:ENGEL, MICAH BRYAN (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MICAH BRYAN
Middle Name:
Last Name:ENGEL
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 JEWEL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1744
Mailing Address - Country:US
Mailing Address - Phone:718-673-2002
Mailing Address - Fax:
Practice Address - Street 1:14402 JEWEL AVE STE A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1744
Practice Address - Country:US
Practice Address - Phone:718-673-2002
Practice Address - Fax:855-932-4886
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62825363LP0808X
NH084197-23363LP0808X
MARN2351665363LP0808X
NJ26NJ01196200363LP0808X
FL11008307363LP0808X
NY402700363LP0808X
NY687686-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty