Basic Information
| Provider Information | |||||||||
| NPI: | 1912292186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLILI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E. NEW YORK AVE | ||||||||
| Address2: | 4TH FLOOR - SPG | ||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533994 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 SHORE RD | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082252136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093655300 | ||||||||
| FaxNumber: | 6093655306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OT014247 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MB09864800 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.