Provider Demographics
NPI:1356425128
Name:MIRON, MIKE (MD)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:MIRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIHNEA
Other - Middle Name:
Other - Last Name:MIRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:40-04 KILADA COURT
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5342
Mailing Address - Country:US
Mailing Address - Phone:201-791-1178
Mailing Address - Fax:201-791-6226
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:STE 402
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:914-378-0377
Practice Address - Fax:914-378-0372
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1706241207W00000X
NJMA04779100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0036507OtherGHI
NY01026195Medicaid
NY040426012288OtherFIDELIS CARE
NY1053130001OtherDME
NJ47791OtherMAGNACARE
NJWS1270OtherOXFORD
NJ0036507OtherGHI
NY18003346OtherRAILROAD MEDICARE
NJ1974807Medicaid
NY00E531OtherEMPIRE BCBS
NY0H1451OtherHEALTHNET
NJ0K7798OtherHEALTHNET
NYWS1270OtherOXFORD
NY1005794OtherAETNA
NJ16205OtherAETNA
NYHIP18102OtherHIP
NJ16205OtherAETNA
NJ455545Medicare ID - Type Unspecified
NY01026195Medicaid