Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MA69170 | NJ |
NPI | 1073505061 |
---|---|
Provider Name | Dr. Juan Baez |
First Address | Warren, NJ 07059-5316 |
Second Address | Warren, NJ 07059-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 03/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H04777 | (02) | NJ |