Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00339500 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00339500 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | 25MD00339500 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | 25MD00339500 | NJ |
NPI | 1043319122 |
---|---|
Provider Name | Dr. Justin Fleming |
First Address | Somerset, NJ 08873-1369 |
Second Address | Somerset, NJ 08873-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 07/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U94792 | (02) | PA |