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General NPI Number Information
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NPI Number | 1598316002
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Entity Type | Individual
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Provider Name | THEODORE MILLER FNP
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Gender | Male
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 179 SULLIVAN ST
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City | NEW YORK
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State | NY
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Zip | 10012-2545
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Country | US
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Telephone | 212-677-6788
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Fax | 205-273-3534
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Provider Business Mailing Address
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Address Line | 161 KNOB HILL DR
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City | HAMDEN
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State | CT
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Zip | 06518-2448
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Country | US
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Telephone | 720-235-7316
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15197700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14156
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP031741
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345051
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License Number State | NY
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