Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 25MA05970000 | NJ |
NPI | 1104999705 |
---|---|
Provider Name | Dr. Graciano F. Avendano |
First Address | East Brunswick, NJ 08816-7600 |
Second Address | East Brunswick, NJ 08816-7600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G48983 | (02) | NJ |