Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QS01771900 | NJ |
Y | 225100000X | Physical Therapist | 40QA01771900 | NJ |
NPI | 1053819862 |
---|---|
Provider Name | Dr. Christopher R Faber |
First Address | Matawan, NJ 07747-2132 |
Second Address | Matawan, NJ 07747-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40QAO1771900 | LICENSED (01) | NJ |