Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 059969 | NY |
NPI | 1093169799 |
---|---|
Provider Name | Bertram Strachan JR. |
First Address | Woodbridge, NJ 07095-2632 |
Second Address | Woodbridge, NJ 07095-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 16/04/2019 |