Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD453281 | PA |
NPI | 1023242393 |
---|---|
Provider Name | Benjamin P Laferriere |
First Address | Madison, NJ 07940-1234 |
Second Address | Export, PA 15632-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 19/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023242393 | N/A (01) |