1124453998 NPI number — BRIAN A MILLER PT, DPT

Table of content: BRIAN A MILLER PT, DPT (NPI 1124453998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124453998 NPI number — BRIAN A MILLER PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
BRIAN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

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:
1124453998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-580-5200
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 NORTH AVE E STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07016-2491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-276-0237
Provider Business Practice Location Address Fax Number:
908-276-5692
Provider Enumeration Date:
09/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01513900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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