Provider Demographics
NPI:1609897198
Name:MILLILI, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:MILLILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1718
Mailing Address - Country:US
Mailing Address - Phone:856-845-0500
Mailing Address - Fax:856-384-8757
Practice Address - Street 1:127 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1718
Practice Address - Country:US
Practice Address - Phone:856-845-0500
Practice Address - Fax:856-384-8757
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04424200208600000X
PAMD024812E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0456585000OtherAMERIHEALTH
NJ2356805Medicaid
PA0011963240003Medicaid
NJ0075290000OtherAMERIHEALTH
C60163Medicare UPIN
NJ2356805Medicaid
PA0011963240003Medicaid