Provider Demographics
NPI:1811977283
Name:MIRELS, HILTON (MD, FCS)
Entity type:Individual
Prefix:
First Name:HILTON
Middle Name:
Last Name:MIRELS
Suffix:
Gender:M
Credentials:MD, FCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MEMORIAL HWY
Mailing Address - Street 2:SUITE 1-15
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5635
Mailing Address - Country:US
Mailing Address - Phone:914-632-2251
Mailing Address - Fax:
Practice Address - Street 1:175 MEMORIAL HWY
Practice Address - Street 2:SUITE 1-15
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5635
Practice Address - Country:US
Practice Address - Phone:914-632-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179417207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01142290Medicaid
NY01142290Medicaid
NY26F631Medicare PIN