Healthcare Provider Details

I. General information

NPI: 1932101961
Provider Name (Legal Business Name): ERIC MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 MAIN ST STE 4
LUMBERTON NJ
08048-5016
US

IV. Provider business mailing address

2 EVES DR SUITE 109
MARLTON NJ
08053-3193
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-7050
  • Fax: 609-267-7065
Mailing address:
  • Phone: 856-669-6061
  • Fax: 856-651-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA05474600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: