Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 25MB10800300 | NJ |
NPI | 1578003976 |
---|---|
Provider Name | Alexander King |
First Address | Sewell, NJ 08080 |
Second Address | Sewell, NJ 08080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2017 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1N7353 | MEDICARE PIN (01) | NJ |