Healthcare Provider Details

I. General information

NPI: 1982689741
Provider Name (Legal Business Name): SCOTT T. MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE B4-333
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE BOX 49
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4714
  • Fax: 718-270-1985
Mailing address:
  • Phone: 718-270-2843
  • Fax: 718-270-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number134294-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: