Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 57722 | NJ |
NPI | 1013918416 |
---|---|
Provider Name | Brook A Dejene |
First Address | Morristown, NJ 07960-6136 |
Second Address | Neptune, NJ 07753-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6410600 | (05) | NY |
F68254 | (02) |