Provider Demographics
NPI:1609843176
Name:MILLER, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA ANN
Middle Name:
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 1:170 PROSPECT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1820
Mailing Address - Country:US
Mailing Address - Phone:201-488-2288
Mailing Address - Fax:201-488-4498
Practice Address - Street 1:170 PROSPECT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1820
Practice Address - Country:US
Practice Address - Phone:201-488-2288
Practice Address - Fax:201-488-4498
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059257207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF36618Medicare UPIN
028767Medicare ID - Type Unspecified