Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MA76501 | NJ |
NPI | 1164547360 |
---|---|
Provider Name | Dr. John Bickford |
First Address | New York, NY 10016 |
Second Address | Newark, NJ 07112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |