Basic Information
| Provider Information | |||||||||
| NPI: | 1023157708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 378 MOHONK RD | ||||||||
| Address2: | |||||||||
| City: | HIGH FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124405301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456870478 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 JON BARRETT RD | ||||||||
| Address2: | |||||||||
| City: | PATTERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125632164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458789078 | ||||||||
| FaxNumber: | 8458783203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 004585 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.