Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA03916500 | NJ |
NPI | 1013131861 |
---|---|
Provider Name | Dr. Alfredo G Festa |
First Address | Clifton, NJ 07015-2475 |
Second Address | Union City, NJ 07087-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3803503 | (05) | NJ |
C55332 | (02) | NJ |