Basic Information
| Provider Information | |||||||||
| NPI: | 1396772281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLSTEIN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080971253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568458600 | ||||||||
| FaxNumber: | 8568450535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1006 MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080971253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568458600 | ||||||||
| FaxNumber: | 8568450535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD043011L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MA68033 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA06803300 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7629800 | 05 | NJ | MEDICAID |