Provider Demographics
NPI:1245416866
Name:GREGORY D MILLS DPM
Entity Type:Organization
Organization Name:GREGORY D MILLS DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-751-3313
Mailing Address - Street 1:1930 ROUTE 70 E STE L60
Mailing Address - Street 2:THE EXECUTIVE MEWS
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4201
Mailing Address - Country:US
Mailing Address - Phone:856-751-3313
Mailing Address - Fax:856-751-8370
Practice Address - Street 1:1930 ROUTE 70 E STE L60
Practice Address - Street 2:THE EXECUTIVE MEWS
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4201
Practice Address - Country:US
Practice Address - Phone:856-751-3313
Practice Address - Fax:856-751-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD16968332B00000X
NJMD1968332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0261610001Medicare NSC
NJU24483Medicare UPIN