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General NPI Number Information
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NPI Number | 1164424099
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Entity Type | Individual
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Provider Name | KENNETH MARC MILLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 311 E 79TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-0903
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Country | US
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Telephone | 212-996-6633
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Fax | 212-996-6677
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Provider Business Mailing Address
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Address Line | PO BOX 780217
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City | MASPETH
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State | NY
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Zip | 11378-0217
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Country | US
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Telephone | 718-639-8827
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Fax | 718-639-8811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 210303
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License Number State | NY
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