Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02371800 | NJ |
NPI | 1053579847 |
---|---|
Provider Name | Dr. Brian No |
First Address | Bronx, NY 10467-2512 |
Second Address | Midland Park, NJ 07432-1606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 28/05/2008 |