Provider Demographics
NPI:1275148108
Name:MILLER, ISRAEL (LSW)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:YISROEL
Other - Middle Name:MEIR
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 SHEMEN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3662
Mailing Address - Country:US
Mailing Address - Phone:732-678-6107
Mailing Address - Fax:
Practice Address - Street 1:725 AIRPORT RD STE 7G
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5968
Practice Address - Country:US
Practice Address - Phone:732-678-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06573800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker