Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA022573 | NJ |
NPI | 1568441970 |
---|---|
Provider Name | Dr. Gerald F. Fenster |
First Address | Somerville, NJ 08876-2017 |
Second Address | Somerville, NJ 08876-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
459072 | MEDICARE GROUP # (01) | NJ |
C59545 | (02) | NJ |