Provider Demographics
NPI:1245688019
Name:MILLER, CARLOS ANTONIO (RN)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:1706 MANATUCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1556
Mailing Address - Country:US
Mailing Address - Phone:516-216-2955
Mailing Address - Fax:631-231-2389
Practice Address - Street 1:14202 20TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11351-3000
Practice Address - Country:US
Practice Address - Phone:718-559-0516
Practice Address - Fax:718-358-7502
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY629863-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult