=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578428868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLIN MILLER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MARKET ST STE 4B
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-456-9960
-----------------------------------------------------
Fax | 845-345-6504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1246
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12602-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-809-8256
-----------------------------------------------------
Fax | 845-345-6504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2478L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------