Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00176600 | NJ |
NPI | 1255403184 |
---|---|
Provider Name | Dr. Larry A Goldfarb |
First Address | Morris Plains, NJ 07950-2315 |
Second Address | Morris Plains, NJ 07950-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T99396 | (02) | NJ |