Active NPI
Calvin Miller
- Physician Assistant
- Middletown, NY
National Provider Identifier
1437356706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000164
- Practice address
- 111 Maltese Dr
Middletown, NY 10940-2115 - Phone
- (845) 342-4774
- Fax
- (845) 818-7555
- NPI assigned
- Jun 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000164 | NY | Primary |
Addresses
Primary practice location
111 Maltese Dr
Middletown, NY 10940-2115
Mailing address
111 Maltese Dr
Middletown, NY 10940-2115
Phone (845) 342-4774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NYS LICENSE | Other | NY | 000164 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000164 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437356706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 MALTESE DR",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109402115",
"telephone_number": "845-342-4774",
"fax_number": "845-818-7555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 MALTESE DR",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109402115",
"telephone_number": "845-342-4774",
"fax_number": "845-818-7555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "CALVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000164",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "000164",
"identifier": "NYS LICENSE",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.