Provider Demographics
NPI:1720008907
Name:ETIENNE, MILL (MD)
Entity type:Individual
Prefix:DR
First Name:MILL
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:100 ROUTE 59 STE 101
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-368-8808
Practice Address - Fax:845-357-0709
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2297372084N0400X, 2084N0600X, 2084P0301X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783493Medicaid