Provider Demographics
NPI:1891157350
Name:MILLER, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:622 W 168TH ST PH 17
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-5903
Mailing Address - Fax:212-342-5756
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5903
Practice Address - Fax:212-342-5756
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2022-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2996082080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology