Provider Demographics
NPI:1801528732
Name:MILLER, ILENE (LM, CNM, MSN)
Entity type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LM, CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MADISON ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1603
Mailing Address - Country:US
Mailing Address - Phone:917-816-4498
Mailing Address - Fax:
Practice Address - Street 1:THE GUIRGUIS OBSTETRICS & GYNECOLOGY GROUP
Practice Address - Street 2:522 THIRD ST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-768-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678833163WP1700X
NY002154367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP1700XNursing Service ProvidersRegistered NursePerinatal