NPIMap

Organization Active NPI

Mih Experience LTD

  • Addiction (Substance Use Disorder) Counselor
  • New York, NY
National Provider Identifier
1124423520
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
MIH EXPERIENCE LTD
Practice address
311 Audubon Ave
2ND Floor
New York, NY 10033-4237
Phone
(212) 256-0725
Fax
(917) 261-4704
NPI assigned
Oct 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Fernando Taveras, MDNPI 1194769067
Title
Owner/Physician
Phone
(212) 256-0725

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

311 Audubon Ave
2ND Floor
New York, NY 10033-4237

Mailing address

311 Audubon Ave
2ND Floor
New York, NY 10033-4237
Phone (212) 256-0725

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150213001370 NY Part B Supplier - Clinic/Group Practice 8527383579 Receives reassigned benefits from 2 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

4580 Broadway
Frnt 1
New York, NY 10040
Phone (212) 928-2020

629 W 185th St
Fl 3
New York, NY 10033
Phone (212) 543-3500

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1124423520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 AUDUBON AVE",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334237",
            "telephone_number": "212-256-0725",
            "fax_number": "917-261-4704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 AUDUBON AVE",
            "address_2": "2ND FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334237",
            "telephone_number": "212-256-0725",
            "fax_number": "917-261-4704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIH EXPERIENCE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-28",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "TAVERAS",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "212-256-0725",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.