Provider Demographics
NPI:1750193181
Name:MILY, HASINA A
Entity type:Individual
Prefix:
First Name:HASINA
Middle Name:A
Last Name:MILY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 SKILLMAN AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4136
Mailing Address - Country:US
Mailing Address - Phone:914-498-1820
Mailing Address - Fax:718-255-1025
Practice Address - Street 1:5331 SKILLMAN AVE APT 2R
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4136
Practice Address - Country:US
Practice Address - Phone:914-498-1280
Practice Address - Fax:718-255-1025
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLA-1883175305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization