Basic Information
| Provider Information | |||||||||
| NPI: | 1639460942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILEWSKI | ||||||||
| FirstName: | BECKY | ||||||||
| MiddleName: | LYNN GREY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LCGC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GREY | ||||||||
| OtherFirstName: | BECKY | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, LCGC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 120 HAYDEN AVE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198041745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023548438 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 481 EDWARD H ROSS DR | ||||||||
| Address2: | |||||||||
| City: | ELMWOOD PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074073118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887291206 | ||||||||
| FaxNumber: | 3026234845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2011 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | GC000164 | PA | N | Other Service Providers | Genetic Counselor, MS | 170300000X | 0000003 | DE | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.