Provider Demographics
NPI:1679870083
Name:MIKE MIRON, M.D.,P.C.
Entity type:Organization
Organization Name:MIKE MIRON, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-1178
Mailing Address - Street 1:40-04 KILADA CT
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5342
Mailing Address - Country:US
Mailing Address - Phone:201-791-1178
Mailing Address - Fax:201-791-6226
Practice Address - Street 1:40-04 KILADA CT
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5342
Practice Address - Country:US
Practice Address - Phone:201-791-1178
Practice Address - Fax:201-791-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04779200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01026195Medicaid
1356425128OtherNPI FOR INDIVIDUAL PRACTITIONER MIKE MIRON,MD USED BY ALL INSURANCES
NJ1974807Medicaid
NY00E531Medicare PIN
NJ455545Medicare PIN