Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MA06223900 | NJ |
NPI | 1316919517 |
---|---|
Provider Name | Dr. Mark Anthony Testaiuti |
First Address | Mount Laurel, NJ 08054-1110 |
Second Address | Mount Laurel, NJ 08054-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 11/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12266 | (02) | NJ |