Provider Demographics
NPI:1700091055
Name:MILLIE R FELL MD PC
Entity Type:Organization
Organization Name:MILLIE R FELL MD PC
Other - Org Name:BRIGHTON EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-339-6868
Mailing Address - Street 1:2025 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1463
Mailing Address - Country:US
Mailing Address - Phone:718-339-6868
Mailing Address - Fax:718-627-7219
Practice Address - Street 1:2025 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1463
Practice Address - Country:US
Practice Address - Phone:718-339-6868
Practice Address - Fax:718-627-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002206311Medicaid
NYCK8914OtherRAILROAD MEDICARE
NY002206311Medicaid