Individual
DR. KENNETH MARC MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
311 E 79TH ST, NEW YORK, NY 10021-0903
(212) 996-6633
(212) 996-6677
Mailing address
PO BOX 780217, MASPETH, NY 11378-0217
(718) 639-8827
(718) 639-8811
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
210303
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02133062
—
NY
01
—
1V7471
EMPIRE BLUE CROSS BLUE SH
NY
01
—
2595177
GHI
NY
01
—
4C0580
HEALTH PLAN OF NEW YORK
NY
01
—
MK0303
ATLANTIS
NY
01
—
P2479763
OXFORD HEALTH PLAN
NY
Enumeration date
08/11/2005
Last updated
03/24/2008
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