Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA07808900 | NJ |
N | 2081S0010X | Sports Medicine | 231025-3 | NY |
N | 213ES0000X | Sports Medicine | 231025-3 | NY |
NPI | 1205968310 |
---|---|
Provider Name | Dr. Alexander Joseph Visco |
First Address | Hoboken, NJ 07030-3283 |
Second Address | Hoboken, NJ 07030-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 22/06/2009 |