Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 25MA05506900 | NJ |
NPI | 1396732624 |
---|---|
Provider Name | Dr. Edward Lubat |
First Address | Waldwick, NJ 07463-1749 |
Second Address | Waldwick, NJ 07463-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 09/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5155703 | (05) | NJ |
A61867 | (02) | NJ |