Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | MA69484 | NJ |
NPI | 1265452221 |
---|---|
Provider Name | Bruno Molino |
First Address | Jersey City, NJ 07302 |
Second Address | Jersey City, NJ 07302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I29212 | (02) |