Healthcare Provider Details

I. General information

NPI: 1497597066
Provider Name (Legal Business Name): SAMANTHA ALI MILETTA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BUCK ST
MILLVILLE NJ
08332-3817
US

IV. Provider business mailing address

205 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-1011
  • Fax: 856-327-1333
Mailing address:
  • Phone: 856-455-5500
  • Fax: 856-455-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00728600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: