Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DI7529 | NJ |
NPI | 1003963737 |
---|---|
Provider Name | Dr. Barry D Elbaum |
First Address | Oakhurst, NJ 07755-1617 |
Second Address | Ocean, NJ 07712-4043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 24/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022903 | (05) | NJ |
T77601 | (02) | NJ |