Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 25MA03529000 | NJ |
NPI | 1154462687 |
---|---|
Provider Name | Abraham Aviv |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07107-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0922307 | (05) | NJ |
E61997 | (02) | NJ |