Provider Demographics
NPI:1679712418
Name:MILLER, JASON HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:HARRIS
Last Name:MILLER
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 1:77 SCHANCK RD # 55
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2964
Mailing Address - Country:US
Mailing Address - Phone:732-462-9800
Mailing Address - Fax:732-308-1647
Practice Address - Street 1:77 SCHANCK RD # 55
Practice Address - Street 2:SUITE B-3
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-462-9800
Practice Address - Fax:732-308-1647
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08560500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158106CVROtherCMS-MEDICARE GROUP MEMBER PTAN