MEDICARE: DR. MARTIN G MILLER D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N003272	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	4103190001	OTHER	NY	MEDICARE DMERC NSC #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0057760	OTHER	NY	GHI PROVIDER ID #
2	21214	OTHER	NY	VYTRA PROVIDER ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4405430	OTHER	NY	OXFORD PROVIDER ID #
6	A08008182	OTHER	NY	DMERC SUBMITTER ID #
7	0880916	OTHER	NY	AETNA USHC PROVIDER ID #

General Provider Information

NPI Number	:	1194729780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN G MILLER D.P.M.

Provider Business Mailing Address
First Line	:	88 HARMON ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2712
Country	:	US
Telephone Number	:	516-889-7056
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 ATLANTIC AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-5103
Country	:	US
Telephone Number	:	516-867-0560
Fax Number	:	516-867-0561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	03/28/2008

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