Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 25MA02533700 | NJ |
N | 207NS0135X | Procedural Dermatology | 25MA02533700 | NJ |
NPI | 1376696997 |
---|---|
Provider Name | Dr. George Kihiczak |
First Address | Millburn, NJ 07041-1943 |
Second Address | Millburn, NJ 07041-1943 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1554701 | (05) | NJ |
C55349 | (02) | NJ |