Provider Demographics
NPI:1457359499
Name:MILLER, DAVID EUGENE (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EUGENE
Last Name:MILLER
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 1:233 E SHORE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2433
Mailing Address - Country:US
Mailing Address - Phone:516-773-4500
Mailing Address - Fax:516-773-9896
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-773-4500
Practice Address - Fax:516-773-9896
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY693551OtherEMPIRE BC/BS
NYAS791OtherOXFORD
NY693551OtherEMPIRE BC/BS
NYAS791OtherOXFORD
D47784Medicare UPIN