Provider Demographics
NPI:1386651339
Name:SULLIVAN MILLER, JULIA (MD PH D)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:SULLIVAN MILLER
Suffix:
Gender:F
Credentials:MD PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2500
Mailing Address - Country:US
Mailing Address - Phone:732-548-3200
Mailing Address - Fax:
Practice Address - Street 1:1150 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2500
Practice Address - Country:US
Practice Address - Phone:732-548-3200
Practice Address - Fax:732-548-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07578700207W00000X
NY220593-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3214351OtherAETNA
NJP3033065OtherOXFORD
NJP3033065OtherOXFORD
H97307Medicare UPIN