Provider Demographics
NPI:1750697074
Name:MILLIE R FELL MD PC
Entity type:Organization
Organization Name:MILLIE R FELL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206311Medicaid
NY02206311Medicaid
NYWF5111Medicare PIN