Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 25MA05981200 | NJ |
NPI | 1023184918 |
---|---|
Provider Name | Anusak Yiengpruksawan |
First Address | Paramus, NJ 07652-3628 |
Second Address | Paramus, NJ 07652-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 19/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E94793 | (02) | NJ |