Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 25MA04027000 | NJ |
NPI | 1104992890 |
---|---|
Provider Name | Dr. Hamilton C Goulart |
First Address | Ridgewood, NJ 07450-4407 |
Second Address | Ridgewood, NJ 07450-4407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B19156 | (02) | NJ |