Provider Demographics
NPI:1598316002
Name:MILLER, THEODORE (FNP)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 KNOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2448
Mailing Address - Country:US
Mailing Address - Phone:720-235-7316
Mailing Address - Fax:
Practice Address - Street 1:179 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2545
Practice Address - Country:US
Practice Address - Phone:212-677-6788
Practice Address - Fax:205-273-3534
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15197700363LF0000X
CT14156363LF0000X
PASP031741363LF0000X
NY345051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily