Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MA054879 | NJ |
NPI | 1043302110 |
---|---|
Provider Name | Dr. Edward Von Der Schmidt III |
First Address | Princeton, NJ 08540-3521 |
Second Address | Princeton, NJ 08540-3521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E60126 | (02) | NJ |