Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MDO0253800 | NJ |
Y | 222Z00000X | Podiatrist | 25MDO0253800 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | MD02538 | NJ |
N | 213ES0131X | Foot Surgery | MD02538 | NJ |
NPI | 1275519738 |
---|---|
Provider Name | Dr. Marc Leonard Mizrachy |
First Address | Hillsborough, NJ 08844 |
Second Address | Hillsborough, NJ 08844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 17/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7369601 | (05) | NJ |
U75028 | (02) | |
U75028 | (02) | NJ |