Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00336400 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00336400 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | P97883 | NY |
NPI | 1013399211 |
---|---|
Provider Name | Dr. Danny Phan |
First Address | Metuchen, NJ 08840-2294 |
Second Address | Metuchen, NJ 08840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 28/12/2018 |