Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI01589000 | NJ |
NPI | 1033310461 |
---|---|
Provider Name | Amos Michael Barnes |
First Address | Orange, NJ 07050-3115 |
Second Address | Orange, NJ 07050-3115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/07/2007 |