Healthcare Provider Details

I. General information

NPI: 1669905535
Provider Name (Legal Business Name): LAURA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT PLEASANT AVE STE 105
WEST ORANGE NJ
07052-2751
US

IV. Provider business mailing address

375 MOUNT PLEASANT AVE STE 105
WEST ORANGE NJ
07052-2751
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-6900
  • Fax: 973-322-6999
Mailing address:
  • Phone: 973-322-6900
  • Fax: 973-322-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA12827600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number25MA12827600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: