Basic Information
| Provider Information | |||||||||
| NPI: | 1285823559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILGRAM | ||||||||
| FirstName: | IRINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 BRUNSWICK WOODS DR | ||||||||
| Address2: | |||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088165601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322540081 | ||||||||
| FaxNumber: | 7322542851 | ||||||||
| Practice Location | |||||||||
| Address1: | 561 CRANBURY RD | ||||||||
| Address2: | SUITE L | ||||||||
| City: | EAST BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088165400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323901883 | ||||||||
| FaxNumber: | 7329071711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 12/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP00189100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.