Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1856970 | MA |
N | 1223D0004X | Dentist Anesthesiologist | 0401416374 | VA |
Y | 1223D0004X | Dentist Anesthesiologist | 11925 | CT |
NPI | 1457737454 |
---|---|
Provider Name | Dr. Eric Han |
First Address | Fort Lee, NJ 07024-7216 |
Second Address | Windsor, CT 06095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 16/05/2019 |