Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 81945 | MA |
NPI | 1053379073 |
---|---|
Provider Name | Dr. Jacob Pieter Noordzij |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02118-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2123002 | (05) | MA |