Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00134700 | NJ |
NPI | 1396748281 |
---|---|
Provider Name | Dr. Barry R. Mullen |
First Address | Hackettstown, NJ 07840-4001 |
Second Address | Hackettstown, NJ 07840-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T45640 | (02) | NJ |