Provider Demographics
NPI:1891085916
Name:MILLER, JENNIFER EARLE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EARLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-264-3600
Mailing Address - Fax:
Practice Address - Street 1:3 CROSSING BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4172
Practice Address - Country:US
Practice Address - Phone:518-264-3600
Practice Address - Fax:518-264-3604
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277944208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation