Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 27OA00433900 | NJ |
NPI | 1013190800 |
---|---|
Provider Name | Dr. Ira Joseph Hanlon |
First Address | East Brunswick, NJ 08816-2374 |
Second Address | East Brunswick, NJ 08816-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2007 |
Last Update Date | 04/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01546 | (02) | NJ |