Healthcare Provider Details

I. General information

NPI: 1083293377
Provider Name (Legal Business Name): JARAD STEVEN MILLER MS, CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10275 HAGEN RANCH RD
BOYNTON BEACH FL
33437-3783
US

IV. Provider business mailing address

140 ADAMS AVE
HAUPPAUGE NY
11788-3618
US

V. Phone/Fax

Practice location:
  • Phone: 561-300-1400
  • Fax:
Mailing address:
  • Phone: 631-617-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: