Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 25MA09761800 | NJ |
NPI | 1104060102 |
---|---|
Provider Name | Amit C Misra |
First Address | Long Branch, NJ 07740-6303 |
Second Address | Long Branch, NJ 07740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2009 |
Last Update Date | 14/10/2015 |