Provider Demographics
NPI:1316942618
Name:MILLER, GEORGE WALTER JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTER
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MOUNTAINSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4208
Mailing Address - Country:US
Mailing Address - Phone:973-628-0427
Mailing Address - Fax:973-872-0096
Practice Address - Street 1:799 BLOOMFIELD AVE STE 201
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-746-7050
Practice Address - Fax:973-857-2831
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03913700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7241607Medicaid
NJF08926Medicare UPIN
NJ450169Medicare ID - Type UnspecifiedMEDICARE NUMBER