Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | NJ8925 | NJ |
NPI | 1023158045 |
---|---|
Provider Name | Dr. Joseph Kornbleuth |
First Address | Cinnaminson, NJ 08077 |
Second Address | Cinnaminson, NJ 08077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |