Provider Demographics
NPI:1851367569
Name:MILLER, CLIFFORD (MS,APRN,BC-FNP)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS,APRN,BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3620
Mailing Address - Country:US
Mailing Address - Phone:631-666-3951
Mailing Address - Fax:631-750-1177
Practice Address - Street 1:280 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8403
Practice Address - Country:US
Practice Address - Phone:631-758-4444
Practice Address - Fax:631-758-1984
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3325292084N0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02439196Medicaid
NY92N421Medicare ID - Type Unspecified
NY02439196Medicaid
NY363LF0000XMedicare UPIN