Provider Demographics
NPI:1982091880
Name:MILLER, PHILIP I
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MILLER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BLAUVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1206
Mailing Address - Country:US
Mailing Address - Phone:212-678-4990
Mailing Address - Fax:121-266-5178
Practice Address - Street 1:121 WEST 111TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026
Practice Address - Country:US
Practice Address - Phone:212-679-4990
Practice Address - Fax:121-266-5179
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17937101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)