Healthcare Provider Details

I. General information

NPI: 1093825861
Provider Name (Legal Business Name): JEFFREY MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 CLIFTON AVE STE 110
CLIFTON NJ
07013-3517
US

IV. Provider business mailing address

1033 CLIFTON AVE STE 110
CLIFTON NJ
07013-3517
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-2208
  • Fax: 973-777-4895
Mailing address:
  • Phone: 973-365-2208
  • Fax: 973-777-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00120300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: