Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MB05445900 | NJ |
Y | 111NI0900X | Internist | 25MB05445900 | NJ |
N | 207RG0300X | Geriatric Medicine | 25MB05445900 | NJ |
NPI | 1093708067 |
---|---|
Provider Name | Donald R Noll |
First Address | Stratford, NJ 08084-1354 |
Second Address | Stratford, NJ 08084-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0225967 | (05) | NJ |
F38417 | (02) |