Healthcare Provider Details

I. General information

NPI: 1649327644
Provider Name (Legal Business Name): EDWARD J MILLER JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 60TH ST SUITE 7A
NEW YORK NY
10022-1117
US

IV. Provider business mailing address

121 E 60TH ST SUITE 7A
NEW YORK NY
10022-1117
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-5895
  • Fax: 212-838-6007
Mailing address:
  • Phone: 212-838-5895
  • Fax: 212-838-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number044671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number004671
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: