Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00051700 | NJ |
NPI | 1023003597 |
---|---|
Provider Name | Andrew Thomas |
First Address | New Brunswick, NJ 08901-1928 |
Second Address | New Brunswick, NJ 08901-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01277884 | (05) | NJ |
Q23257 | (02) | NJ |