Healthcare Provider Details

I. General information

NPI: 1578428868
Provider Name (Legal Business Name): COLLIN MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MARKET ST STE 4B
POUGHKEEPSIE NY
12601-3210
US

IV. Provider business mailing address

PO BOX 1246
POUGHKEEPSIE NY
12602-1246
US

V. Phone/Fax

Practice location:
  • Phone: 914-456-9960
  • Fax: 845-345-6504
Mailing address:
  • Phone: 845-809-8256
  • Fax: 845-345-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2478L001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: