Organization Name: | VA MEDICAL CENTER |
NPI Number: | 1073698858 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEFAN MILLER (PHYSICIAN ASSISTANT) |
Mailing Address: | Va Medical Center 79 Middleville Rd - Cardiology 111 Northport |
State: | NY US |
Postal Code: | 11768 |
Phone Number: | 6312614400 |
Fax Number: | |
NPI Enumeration Date: | 10/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 000277 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |