Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA09966600 | NJ |
NPI | 1003109893 |
---|---|
Provider Name | Dr. Erik Dienna |
First Address | Livingston, NJ 07039-5668 |
Second Address | Livingston, NJ 07039-5668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 27/12/2018 |