1447337183 NPI number — LAWRENCE S MILLER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447337183 NPI number — LAWRENCE S MILLER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MILLER

Provider First Name:

LAWRENCE

Provider Middle Name:

S

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1447337183

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/04/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 FEDERAL ST # 200

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

CAMDEN

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

08103-1088

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

856-356-4924

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

221 VICTORIA ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GLASSBORO

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08028-2278

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-536-1475

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  MA74564 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2130421000 . This is a "AMERIHEALTH/KEYSTON/IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0052412000 . This is a "KEYSTONE/IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 010004388 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2937750 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 42384 . This is a "UNIVERSITY HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 8939403 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 3K5446 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1447021 . This is a "AMERIHEALTH PPO/BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1072456 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 426719 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P395850 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".