Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DI 15624 | NJ |
NPI | 1124031133 |
---|---|
Provider Name | Dr. Jeffrey Lee Flamme |
First Address | Summit, NJ 07901-4717 |
Second Address | Summit, NJ 07901-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 02/08/2011 |