Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA05837900 | NJ |
NPI | 1073554879 |
---|---|
Provider Name | Dr. Joshua R Shua-Haim |
First Address | Manchester, NJ 08759-5806 |
Second Address | Manchester, NJ 08759-5806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6083307 | (05) | NJ |
F45393 | (02) | NJ |