Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | MD002113 | NJ |
NPI | 1053495408 |
---|---|
Provider Name | David M Millili |
First Address | Camden, NJ 08103-1088 |
Second Address | Camden, NJ 08103-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0352328000 | AMERIHEALTH/KEYSTONE/IBC (01) | NJ |
5448301 | (05) | NJ |
MD00211300 | STATE LICENSE (01) | NJ |
T30229 | (02) |