Provider Demographics
NPI:1306874318
Name:MILLER PERFORMING ARTS MEDICINE P.C.
Entity type:Organization
Organization Name:MILLER PERFORMING ARTS MEDICINE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-778-5550
Mailing Address - Street 1:355 W 52ND ST # 7FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6239
Mailing Address - Country:US
Mailing Address - Phone:646-778-5550
Mailing Address - Fax:646-778-5548
Practice Address - Street 1:355 W 52ND ST # 7FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-778-5550
Practice Address - Fax:646-778-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFW8410Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER