Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MA32860 | NJ |
NPI | 1003870163 |
---|---|
Provider Name | Dr. I. Mark Hiatt |
First Address | Rumson, NJ 07760-1030 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0591106 | (05) | NJ |
E15300 | (02) | NJ |