Basic Information
Provider Information
NPI: 1134294606
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: ALBERT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M. D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 42ND ST FL 9
Address2:  
City: NEW YORK
State: NY
PostalCode: 100175699
CountryCode: US
TelephoneNumber: 6466058188
FaxNumber: 2125237410
Practice Location
Address1: FIRST AVENUE AND E16TH STREET
Address2:  
City: NEW YORK
State: NY
PostalCode: 100032575
CountryCode: US
TelephoneNumber: 2124202377
FaxNumber: 2124204684
Other Information
ProviderEnumerationDate: 11/21/2006
LastUpdateDate: 04/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X087472NYY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

ID Information
IDTypeStateIssuerDescription
100874726N05NY MEDICAID


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