Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N002696 | NY |
N | 222Z00000X | Podiatrist | N002696 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00120300 | NJ |
NPI | 1093825861 |
---|---|
Provider Name | Dr. Jeffrey Miller |
First Address | Clifton, NJ 07013-2449 |
Second Address | Clifton, NJ 07013-2450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 04/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3050106 | (05) | NJ |
T45018 | (02) | NJ |