Healthcare Provider Details

I. General information

NPI: 1942298096
Provider Name (Legal Business Name): STEVEN E MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N GILBERT ST SUITE 2101
TINTON FALLS NJ
07701-4904
US

IV. Provider business mailing address

55 N GILBERT ST SUITE 2101
TINTON FALLS NJ
07701-4904
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6677
  • Fax: 732-530-2946
Mailing address:
  • Phone: 732-842-6677
  • Fax: 732-530-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMB48334
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: