Provider Demographics
NPI:1215032552
Name:MILLER, SETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2605
Mailing Address - Country:US
Mailing Address - Phone:516-432-8021
Mailing Address - Fax:516-432-8179
Practice Address - Street 1:724 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-432-8021
Practice Address - Fax:516-432-8179
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146620207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00908094Medicaid
42D871Medicare PIN
NY00908094Medicaid