Individual
BENETTA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
330 GRAND ST, SUITE 100, HOBOKEN, NJ 07030-2728
(201) 420-7903
Mailing address
502 PROSPECT ST, MAPLEWOOD, NJ 07040-1304
(973) 378-2045
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
047836
NJ
208600000X
Surgery Physician
Primary
25MA04783600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100400
—
NJ
Enumeration date
03/09/2007
Last updated
07/21/2022
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