Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DI14138 | NJ |
NPI | 1043332703 |
---|---|
Provider Name | Dr. Leroy Taylor |
First Address | Matawan, NJ 07747-3258 |
Second Address | Matawan, NJ 07747-3258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |