Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 38MC00697700 | NJ |
NPI | 1104184456 |
---|---|
Provider Name | Dr. Larry Ordonez |
First Address | West New York, NJ 07093-1620 |
Second Address | West New York, NJ 07093-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 30/04/2012 |