Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MA06528400 | NJ |
NPI | 1073574661 |
---|---|
Provider Name | Dr. Lincoln Miller |
First Address | Madison, NJ 07940-8268 |
Second Address | West Orange, NJ 07052-2956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 16/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7230800 | (05) | NJ |
E99065 | (02) | NJ |