Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 25MB10141500 | NJ |
NPI | 1053662379 |
---|---|
Provider Name | Dr. Marc Thomas Mongeau |
First Address | Sewell, NJ 08080-2358 |
Second Address | Turnersville, NJ 08012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 01/02/2019 |