Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | OS012499 | PA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 25MB10436200 | NJ |
NPI | 1114979028 |
---|---|
Provider Name | Dr. Brandon Scott Poterjoy |
First Address | Abington, PA 19001-3720 |
Second Address | Abington, PA 19001-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0156086 | (05) | NJ |