Provider Demographics
NPI:1326128737
Name:MILLER, JESSICA SCHUTZBANK (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SCHUTZBANK
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOSPITAL PLZ STE 203
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3084
Mailing Address - Country:US
Mailing Address - Phone:732-631-4410
Mailing Address - Fax:844-350-5451
Practice Address - Street 1:3 HOSPITAL PLZ STE 203
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3084
Practice Address - Country:US
Practice Address - Phone:732-631-4410
Practice Address - Fax:844-350-5451
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7878208100000X
NJ25MA08584900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03234Medicare UPIN