Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA06700000 | NJ |
NPI | 1326113564 |
---|---|
Provider Name | Carl Nath |
First Address | Philadelphia, PA 19178-0001 |
Second Address | Long Branch, NJ 07740-5725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 18/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8382409 | (05) | NJ |
H29217 | (02) | NJ |