Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22D101572800 | NJ |
NPI | 1053584417 |
---|---|
Provider Name | Dr. Marvin A. Kornmehl |
First Address | Howell, NJ 07731-2168 |
Second Address | Howell, NJ 07731-2168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 08/04/2008 |