Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00234400 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00234400 | NJ |
NPI | 1013009794 |
---|---|
Provider Name | Dr. Fawaz Nesheiwat |
First Address | Hackettstown, NJ 07840-4001 |
Second Address | Hackettstown, NJ 07840-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U67411 | (02) | NJ |