Healthcare Provider Details

I. General information

NPI: 1316853435
Provider Name (Legal Business Name): MR. TIMOTHY MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 HANCOCK ST
SOUTH PLAINFIELD NJ
07080-3322
US

IV. Provider business mailing address

120 NEILSON ST APT 315
NEW BRUNSWICK NJ
08901-1460
US

V. Phone/Fax

Practice location:
  • Phone: 908-356-2725
  • Fax:
Mailing address:
  • Phone: 732-647-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00237400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: