Provider Demographics
NPI:1841331543
Name:MILLAN PHYSICAL THERAPY REHABILITATION, P.C.
Entity type:Organization
Organization Name:MILLAN PHYSICAL THERAPY REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:718-494-8595
Mailing Address - Street 1:390 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2957
Mailing Address - Country:US
Mailing Address - Phone:718-494-8595
Mailing Address - Fax:718-494-0191
Practice Address - Street 1:390 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2957
Practice Address - Country:US
Practice Address - Phone:718-494-8595
Practice Address - Fax:718-494-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003366-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46651OtherMULTIPLAN INS
NY0020964OtherGHI INS
NYQ0633Q5JK1OtherCHARLES MILLAN
NYQ5194Q5JK1OtherANNE ORLOSKI
NY17935POtherHIP INS
NYOS183OtherOXFORD INS
NYOS184OtherOXFORD INS
NY0027601OtherCIGNA, HEALTHNET, AETNA
NY17952POtherHIP INS
NYN121364Other1199 INS
NYN121364Other1199 INS