Provider Demographics
NPI:1093825861
Name:MILLER, JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 CLIFTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-365-2208
Mailing Address - Fax:973-777-4895
Practice Address - Street 1:1033 CLIFTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-365-2208
Practice Address - Fax:973-777-4895
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00120300213ES0103X
NYN002696213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3050106Medicaid
NJ444466Medicare PIN
NJT45018Medicare UPIN
NJ3050106Medicaid