Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00124900 | NJ |
NPI | 1427123348 |
---|---|
Provider Name | Dr. Barry A Jansen |
First Address | Fair Lawn, NJ 07410-6018 |
Second Address | Fair Lawn, NJ 07410-6018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 13/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44891 | (02) | NJ |