Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MA029605 | NJ |
NPI | 1003812975 |
---|---|
Provider Name | Bruce W Lefkon |
First Address | West Orange, NJ 07052-1104 |
Second Address | West Orange, NJ 07052-1104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 02/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56431 | (02) |