Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA08445200 | NJ |
NPI | 1154455947 |
---|---|
Provider Name | Dr. Anthony Nmi Festa |
First Address | Wayne, NJ 07470-3534 |
Second Address | Wayne, NJ 07470-3534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 04/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA08445200 | MEDICAL LICENSE (01) | NJ |