Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 25MB09366700 | NJ |
N | 207Q00000X | Family Doctor | 25MB09366700 | NJ |
Y | 207Q00000X | Family Doctor | R7574 | TX |
NPI | 1275829939 |
---|---|
Provider Name | Dr. Knic Corpuz Rabara |
First Address | Mount Laurel, NJ 08054-1149 |
Second Address | Mount Laurel, NJ 08054-1149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 27/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0436011 | (05) | NJ |