Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MA05295600 | NJ |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MA52956 | NJ |
NPI | 1104805647 |
---|---|
Provider Name | Dr. Clint C Ferenz |
First Address | Manasquan, NJ 08736 |
Second Address | Manasquan, NJ 08736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B76196 | (02) | NJ |