Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 25MA10102100 | NJ |
N | 207T00000X | Neurosurgeon | MD460820 | PA |
NPI | 1013216472 |
---|---|
Provider Name | Daniel Roque Felbaum |
First Address | Upland, PA 19013-3902 |
Second Address | Lawrenceville, NJ 08648-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 06/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0580431 | (05) | NJ |