Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI01101000 | NJ |
NPI | 1265582852 |
---|---|
Provider Name | Dr. James Friere Skiba SR. |
First Address | Montclair, NJ 07042-2806 |
Second Address | Montclair, NJ 07042-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U10435 | (02) | NJ |