Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MA51994 | NJ |
NPI | 1235128497 |
---|---|
Provider Name | Dr. Jay Michael Kashkin |
First Address | Fair Lawn, NJ 07410-1559 |
Second Address | Fair Lawn, NJ 07410-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E13159 | (02) | NJ |