Provider Demographics
NPI:1588699987
Name:MILLER, LESLIE JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JENNIFER
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LIBERTY STREET
Mailing Address - Street 2:BASEMENT SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006
Mailing Address - Country:US
Mailing Address - Phone:646-461-2544
Mailing Address - Fax:646-461-2542
Practice Address - Street 1:106 LIBERTY STREET
Practice Address - Street 2:BASEMENT SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006
Practice Address - Country:US
Practice Address - Phone:646-461-2544
Practice Address - Fax:646-461-2542
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-26
Deactivation Date:2006-07-19
Deactivation Code:
Reactivation Date:2007-10-02
Provider Licenses
StateLicense IDTaxonomies
NY191083207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013261Medicare ID - Type Unspecified
G26772Medicare UPIN