Provider Demographics
NPI:1194729780
Name:MILLER, MARTIN G (DPM)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2712
Mailing Address - Country:US
Mailing Address - Phone:516-889-7056
Mailing Address - Fax:
Practice Address - Street 1:23 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5103
Practice Address - Country:US
Practice Address - Phone:516-867-0560
Practice Address - Fax:516-867-0561
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003272213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0057760OtherGHI PROVIDER ID #
NY21214OtherVYTRA PROVIDER ID #
NY4103190001OtherMEDICARE DMERC NSC #
NY00657525Medicaid
NY4405430OtherOXFORD PROVIDER ID #
NYA08008182OtherDMERC SUBMITTER ID #
NY0880916OtherAETNA USHC PROVIDER ID #
NY0057760OtherGHI PROVIDER ID #
NY4405430OtherOXFORD PROVIDER ID #