Provider Demographics
NPI:1952824633
Name:MILENIA IDS LLC
Entity Type:Organization
Organization Name:MILENIA IDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-537-4913
Mailing Address - Street 1:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-0453
Mailing Address - Country:US
Mailing Address - Phone:516-537-4913
Mailing Address - Fax:516-537-4910
Practice Address - Street 1:1510 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1375
Practice Address - Country:US
Practice Address - Phone:516-537-4913
Practice Address - Fax:516-537-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty