Basic Information
| Provider Information | |||||||||
| NPI: | 1215250998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NILES | ||||||||
| FirstName: | PAULOMI | ||||||||
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| Credential: | C.N.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 334 W 85TH ST | ||||||||
| Address2: | APT 3B | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100243825 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 BROADWAY | ||||||||
| Address2: | SUITE 10-100 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112065317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189638532 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2010 | ||||||||
| LastUpdateDate: | 03/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | F001381 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.