Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22DI01293000 | NJ |
NPI | 1053582064 |
---|---|
Provider Name | Dr. Marc Balson |
First Address | Livingston, NJ 07039-4043 |
Second Address | Livingston, NJ 07039-4043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174740567 | ORGANIZATION (01) | NJ |