Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA06432800 | NJ |
Y | 208600000X | Surgeon | 25MA06432800 | NJ |
N | 208200000X | Surgeon | MD041474E | PA |
N | 208600000X | Surgeon | MD041474E | PA |
NPI | 1003811233 |
---|---|
Provider Name | Dr. Frederick B Lavan |
First Address | Woodbury, NJ 08096-3963 |
Second Address | Woodbury, NJ 08096-3963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 29/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7403305 | (05) | NJ |
F83067 | (02) | NJ |
F83067 | (02) | PA |