Healthcare Provider Details

I. General information

NPI: 1457359499
Provider Name (Legal Business Name): DAVID EUGENE MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E SHORE RD SUITE 102
GREAT NECK NY
11023-2433
US

IV. Provider business mailing address

233 E SHORE RD SUITE 102
GREAT NECK NY
11023-2433
US

V. Phone/Fax

Practice location:
  • Phone: 516-773-4500
  • Fax: 516-773-9896
Mailing address:
  • Phone: 516-773-4500
  • Fax: 516-773-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number103820
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: