Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MA63643 | NJ |
NPI | 1003876996 |
---|---|
Provider Name | Dr. Jeffrey Richard Vaninwegen |
First Address | Ramsey, NJ 07446 |
Second Address | Ramsey, NJ 07446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7116209 | (05) | NJ |
G15828 | (02) |