Provider Demographics
NPI:1255307856
Name:MILLER, JOSEPH M (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3200
Mailing Address - Country:US
Mailing Address - Phone:352-220-3066
Mailing Address - Fax:732-449-4407
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:BUILDING A- SUITE 123
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:352-220-3066
Practice Address - Fax:732-449-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07112600207V00000X
FLOS10658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001300800Medicaid
NJ0007234Medicaid
NJ086384SDTMedicare PIN
NJ0007234Medicaid
FLCG653XMedicare PIN
FLCG653XMedicare PIN