Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 54835 | NJ |
N | 207ND0900X | Dermatopathologist | 54835 | NJ |
NPI | 1477557304 |
---|---|
Provider Name | Alan J Liftin |
First Address | Livingston, NJ 07039-5605 |
Second Address | Livingston, NJ 07039-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 25/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605165 | MEDICARE ID (01) | NJ |
E58216 | (02) | NJ |