Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 25MA05449000 | NJ |
NPI | 1275502957 |
---|---|
Provider Name | Aswine K Bal |
First Address | Neptune, NJ 07753-4401 |
Second Address | Neptune, NJ 07753-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F03206 | (02) | NJ |