Provider Demographics
NPI:1467534230
Name:MILLER, JOHN F (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-886-5108
Mailing Address - Fax:518-886-5857
Practice Address - Street 1:3050 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2958
Practice Address - Country:US
Practice Address - Phone:518-886-5108
Practice Address - Fax:518-886-5857
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02509520Medicaid
NYBB5252Medicare PIN
NYPA2285Medicare PIN
R58377Medicare UPIN
NYJ400001539Medicare PIN
NYBB5250Medicare PIN