Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 45PO00009200 | NJ |
NPI | 1194266064 |
---|---|
Provider Name | Brian O'shea |
First Address | Linwood, NJ 08221-2025 |
Second Address | Linwood, NJ 08221-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5417406 | (05) | NJ |