Provider Demographics
NPI:1477808194
Name:MILLER, ANN MARIE (MS ED)
Entity type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 DAVISON ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1912
Mailing Address - Country:US
Mailing Address - Phone:516-594-9224
Mailing Address - Fax:
Practice Address - Street 1:2874 DAVISON ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1912
Practice Address - Country:US
Practice Address - Phone:516-594-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY252Y00000XOtherEARLY INTERVENTION PROVIDER AGENCY