Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 122854 | NY |
NPI | 1023046935 |
---|---|
Provider Name | Dr. Richard Lawrence Miller |
First Address | Setauket, NY 11733-2918 |
Second Address | Setauket, NY 11733-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00230855 | (05) | NY |
AM6680397 | DEA (01) | |
C12461 | (02) | NY |
CD-122854-3 | WORKMANS' COMP (01) | NY |