1366500407 NPI number — JOEL M. MILLER M.D. PC

Table of content: (NPI 1366500407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366500407 NPI number — JOEL M. MILLER M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOEL M. MILLER M.D. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366500407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 NORTHWESTERN DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-3480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-242-6633
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 NORTHWESTERN DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-3480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-242-6633
Provider Business Practice Location Address Fax Number:
860-286-8411
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
860-242-6633

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010015926CT01 . This is a "ANTHEM FEP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0505863 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 053027 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 110008015 . This is a "MEDICARE PART B" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2045215 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 010015926CT01 . This is a "BLUE CROSS BLUE SHIELD CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 01215926 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2522185 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0333001174 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V7294 . This is a "ACS HEALTH NET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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