Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00715200 | NJ |
N | 111NN0400X | Neurology | CHIR009216 | GA |
NPI | 1568842342 |
---|---|
Provider Name | Dr. David E Koentop |
First Address | Marlton, NJ 08053-4112 |
Second Address | Manasquan, NJ 08736-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 15/12/2021 |