Provider Demographics
NPI:1609175058
Name:RICHARD L MILLER M.D.P.C..
Entity Type:Organization
Organization Name:RICHARD L MILLER M.D.P.C..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-7070
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2918
Mailing Address - Country:US
Mailing Address - Phone:631-751-7070
Mailing Address - Fax:631-751-7662
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2918
Practice Address - Country:US
Practice Address - Phone:631-751-7070
Practice Address - Fax:631-751-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122854-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC-12461Medicare UPIN
NY956511Medicare PIN