Basic Information
| Provider Information | |||||||||
| NPI: | 1407071681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLMAN | ||||||||
| FirstName: | PERI | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 W 236TH ST | ||||||||
| Address2: | #4G | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104631748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188841565 | ||||||||
| FaxNumber: | 7188841565 | ||||||||
| Practice Location | |||||||||
| Address1: | 3459 BROADWAY | ||||||||
| Address2: | CH7N-702 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100315629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123057082 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2080P0206X | 232586 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
No ID Information.