Provider Demographics
NPI:1285041772
Name:MILLER, RAYMOND CHARLES III (LMT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHARLES
Last Name:MILLER
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 VALLEY RD
Mailing Address - Street 2:APT3
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1843
Mailing Address - Country:US
Mailing Address - Phone:973-699-7573
Mailing Address - Fax:
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ
Practice Address - Street 2:SUITE29
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1343
Practice Address - Country:US
Practice Address - Phone:973-655-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00658300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist