Provider Demographics
NPI:1396772281
Name:MILLSTEIN, JEFFREY HOWARD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HOWARD
Last Name:MILLSTEIN
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 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1253
Mailing Address - Country:US
Mailing Address - Phone:856-845-8600
Mailing Address - Fax:856-845-0535
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08097-1253
Practice Address - Country:US
Practice Address - Phone:856-845-8600
Practice Address - Fax:856-845-0535
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043011L207R00000X
NJMA68033207R00000X
NJ25MA06803300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7629800Medicaid
E74662Medicare UPIN
NJ017934Medicare PIN