Provider Demographics
NPI:1831588151
Name:MICKLES, GEORGE III
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MICKLES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SARATOGA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2412
Mailing Address - Country:US
Mailing Address - Phone:718-930-9341
Mailing Address - Fax:
Practice Address - Street 1:132 SARATOGA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2412
Practice Address - Country:US
Practice Address - Phone:718-930-9341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5881570344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi