Healthcare Provider Details

I. General information

NPI: 1184725897
Provider Name (Legal Business Name): JEFFREY A MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EVERGREEN PLACE SUITE 400
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

21 EDGEWOOD ROAD
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 973-395-1550
  • Fax: 973-395-1556
Mailing address:
  • Phone: 973-395-1550
  • Fax: 973-395-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMB53988
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: