Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DI02641500 | NJ |
NPI | 1003286378 |
---|---|
Provider Name | Dr. Mal Azar |
First Address | Jersey City, NJ 07302-1427 |
Second Address | Jersey City, NJ 07302-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2015 |
Last Update Date | 05/12/2016 |