Healthcare Provider Details

I. General information

NPI: 1245416866
Provider Name (Legal Business Name): GREGORY D MILLS DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ROUTE 70 E STE L60 THE EXECUTIVE MEWS
CHERRY HILL NJ
08003-4201
US

IV. Provider business mailing address

1930 ROUTE 70 E STE L60 THE EXECUTIVE MEWS
CHERRY HILL NJ
08003-4201
US

V. Phone/Fax

Practice location:
  • Phone: 856-751-3313
  • Fax: 856-751-8370
Mailing address:
  • Phone: 856-751-3313
  • Fax: 856-751-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD16968
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberMD1968
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberMD1968
License Number StateNJ

VIII. Authorized Official

Name: DR. GREGORY D MILLS
Title or Position: OWNER
Credential:
Phone: 856-751-3313