Healthcare Provider Details

I. General information

NPI: 1881586014
Provider Name (Legal Business Name): NICHOLAS JOSEPH MILLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

1218 AVALON PINES DR
CORAM NY
11727-5137
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4233
  • Fax:
Mailing address:
  • Phone: 631-806-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035821
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number035821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: