Provider Demographics
NPI:1508494998
Name:MILLER, ERIC JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JONATHAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 NICHOLLS RD
Mailing Address - Street 2:HEALTH SCIENCE CENTER T16 ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-8160
Mailing Address - Country:US
Mailing Address - Phone:631-444-7411
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:100 NICHOLLS RD
Practice Address - Street 2:HEALTH SCIENCE CENTER T16 ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-8160
Practice Address - Country:US
Practice Address - Phone:631-444-7411
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY324353207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program