Basic Information
Provider Information
NPI: 1265484562
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: ALAN
MiddleName: S.
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 718 TEANECK RD
Address2:  
City: TEANECK
State: NJ
PostalCode: 076664245
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 718 TEANECK RD
Address2:  
City: TEANECK
State: NJ
PostalCode: 076664245
CountryCode: US
TelephoneNumber: 2018333000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2006
LastUpdateDate: 01/26/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X25MAO566400NJN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X2011-00454NCY Allopathic & Osteopathic PhysiciansEmergency Medicine 
207P00000X241790MAN Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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