Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 072575-1 | NY |
NPI | 1003272766 |
---|---|
Provider Name | Mr. Noel K Miller |
First Address | Bronx, NY 10461-3538 |
Second Address | Bronx, NY 10461-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 11/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6313 | PIBLY RESIDENTIAL PROGRAMS (01) | NY |