Provider Demographics
NPI:1487809695
Name:MILLER, LAURENCE H (MSED)
Entity type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SYCAMORE CIR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3168
Mailing Address - Country:US
Mailing Address - Phone:631-804-1757
Mailing Address - Fax:
Practice Address - Street 1:110 SYCAMORE CIR
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3168
Practice Address - Country:US
Practice Address - Phone:631-804-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist