Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 164158 | NY |
NPI | 1376908418 |
---|---|
Provider Name | Robert Miller |
First Address | Glen Cove, NY 11542-2734 |
Second Address | Glen Cove, NY 11542-2734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2015 |
Last Update Date | 16/12/2015 |