Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 25MA06867200 | NJ |
NPI | 1134133945 |
---|---|
Provider Name | Mr. Andrew John Miller |
First Address | Edison, NJ 08837-2500 |
Second Address | Edison, NJ 08837-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2159943 | AETNA (01) | NJ |
G39213 | (02) | |
P1302700 | OXFORD (01) | NJ |