Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA09471300 | NJ |
NPI | 1003011891 |
---|---|
Provider Name | Dr. Etan B Spira |
First Address | Belleville, NJ 07109-3532 |
Second Address | Belleville, NJ 07109-3532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 13/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0415588 | (05) | NJ |