Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 2019411 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | MA067103 | NJ |
NPI | 1558462556 |
---|---|
Provider Name | Dr. Eric Mark Joseph |
First Address | West Orange, NJ 07052 |
Second Address | West Orange, NJ 07052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8442606 | (05) | NJ |
G97215 | (02) |