Provider Demographics
NPI:1093876070
Name:MILLER, ADAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ROCKAWAY AVE
Mailing Address - Street 2:SUITE 206 C
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1665
Mailing Address - Country:US
Mailing Address - Phone:516-567-0139
Mailing Address - Fax:516-593-3291
Practice Address - Street 1:1800 ROCKAWAY AVE
Practice Address - Street 2:SUITE 206 C
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1665
Practice Address - Country:US
Practice Address - Phone:516-567-0139
Practice Address - Fax:516-593-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014877103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02246239Medicaid
NY02246239Medicaid
NYVL5481Medicare PIN