Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 82-1862936 | NJ |
NPI | 1205366903 |
---|---|
Provider Name | David Kreizman |
First Address | Union, NJ 07083 |
Second Address | Union, NJ 07083-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |