Basic Information
| Provider Information | |||||||||
| NPI: | 1609846187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIHAILA | ||||||||
| FirstName: | EMILIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16610 ARCHER AVE | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114331146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188836562 | ||||||||
| FaxNumber: | 7188836503 | ||||||||
| Practice Location | |||||||||
| Address1: | 166-10 ARCHER AVENUE | ||||||||
| Address2: | SUITE A21 | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114321140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188836562 | ||||||||
| FaxNumber: | 7188836503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 016624 | NY | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | 016624 | NY | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0700X | 016624 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | 016624 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 016624 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2717944 | 05 | NY | MEDICAID |