Individual
KENNETH MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD FACC FSCAI
Contact information
Practice address
62 S FULLERTON AVE, MONTCLAIR, NJ 07042-2629
(973) 746-8585
(973) 746-0088
Mailing address
62 S FULLERTON AVE, MONTCLAIR, NJ 07042-2629
(973) 746-8585
(973) 746-0088
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
103421
NJ
207RC0000X
Cardiovascular Disease Physician
Primary
103421
NJ
207RI0011X
Interventional Cardiology Physician
103421
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
742059B82
MEDICARE ID TYPE UNSPECIFIED
NJ
Enumeration date
08/12/2005
Last updated
01/06/2011
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