Provider Demographics
NPI:1760436026
Name:MULLER, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:MULLER
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 1:3500 SUNRISE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-907-2186
Mailing Address - Fax:631-201-3179
Practice Address - Street 1:265 HERRICK ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5045
Practice Address - Country:US
Practice Address - Phone:631-726-8350
Practice Address - Fax:631-726-8519
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200406207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783302Medicaid
NY01783302Medicaid
NY64X341Medicare PIN