Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MA30400 | NJ |
NPI | 1134270903 |
---|---|
Provider Name | Albert Poet |
First Address | Manahawkin, NJ 08050-3828 |
Second Address | Manahawkin, NJ 08050-3828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52791 | (02) | NJ |