Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 469435 | PA |
NPI | 1497119895 |
---|---|
Provider Name | Dr. Garrett D Locketz |
First Address | Jersey City, NJ 07302-5655 |
Second Address | New York, NY 10065-6692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 27/05/2021 |