Provider Demographics
NPI:1700921889
Name:MILMAN, DOUGLAS SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:MILMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE206A
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-379-9561
Mailing Address - Fax:
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE206A
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-379-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY008985101YA0400X, 103T00000X
NY00895103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV30691Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION