Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA04035200 | NJ |
NPI | 1093878910 |
---|---|
Provider Name | Dr. Marc Schoenbrun |
First Address | Fair Lawn, NJ 07410-2324 |
Second Address | Fair Lawn, NJ 07410-2324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |