Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB09256100 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | 25MB09256100 | NJ |
NPI | 1114178142 |
---|---|
Provider Name | David Konigsberg |
First Address | Brick, NJ 08724-3273 |
Second Address | Brick, NJ 08724-3273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0409693 | (05) | NJ |