Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 011085 | ME |
NPI | 1003844150 |
---|---|
Provider Name | Dr. Jay A Naliboff |
First Address | Farmington, ME 04938-6144 |
Second Address | Farmington, ME 04938-6244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B86544 | (02) | ME |