Provider Demographics
NPI:1780607192
Name:FELL, MILLIE R (MD)
Entity type:Individual
Prefix:DR
First Name:MILLIE
Middle Name:R
Last Name:FELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1463
Mailing Address - Country:US
Mailing Address - Phone:718-339-6868
Mailing Address - Fax:718-627-7219
Practice Address - Street 1:2025 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1463
Practice Address - Country:US
Practice Address - Phone:718-339-6868
Practice Address - Fax:718-627-7219
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160237-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01133004Medicaid
NY180024771OtherRAILROAD MEDICARE
NY29E79F5111Medicare PIN
A61957Medicare UPIN