Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 25MA02696600 | NJ |
NPI | 1407952864 |
---|---|
Provider Name | Dr. Loren T Burns |
First Address | Haddonfield, NJ 08033 |
Second Address | Haddonfield, NJ 08033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 28/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D07041 | (02) | NJ |