Provider Demographics
NPI:1316763295
Name:MCMILLAN, GLENDROY MICHAEL
Entity type:Individual
Prefix:
First Name:GLENDROY
Middle Name:MICHAEL
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GLEN
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:91-14 MERRICK BLVD 6TH FL.
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91-14 MERRICK BLVD 6TH FL.
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:201-839-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator