Healthcare Provider Details

I. General information

NPI: 1154367274
Provider Name (Legal Business Name): CONRAD MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL ROAD MEDICAL CENTER
PATCHOGUE NY
11772
US

IV. Provider business mailing address

5600 SUNRISE HWY STAT HEALTH SAYVILLE
SAYVILLE NY
11782-1017
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-7236
  • Fax: 610-617-6280
Mailing address:
  • Phone: 631-360-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number112445
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: