Healthcare Provider Details

I. General information

NPI: 1538164207
Provider Name (Legal Business Name): JEFFREY I MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

IV. Provider business mailing address

10 E PALMETTO PARK RD
BOCA RATON FL
33432-4864
US

V. Phone/Fax

Practice location:
  • Phone: 609-833-9833
  • Fax: 609-407-2364
Mailing address:
  • Phone: 561-955-2330
  • Fax: 561-955-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME64146
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25IA13049500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: