Provider Demographics
NPI:1851542658
Name:MILLER, KARL WAYNE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:WAYNE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3101
Mailing Address - Country:US
Mailing Address - Phone:212-726-6824
Mailing Address - Fax:212-696-0677
Practice Address - Street 1:435 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3101
Practice Address - Country:US
Practice Address - Phone:212-726-6824
Practice Address - Fax:212-696-0677
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004059-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical