Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 22D100866400 | NJ |
NPI | 1306955042 |
---|---|
Provider Name | Dr. Maurice M Maccario |
First Address | Oakland, NJ 07436 |
Second Address | Oakland, NJ 07436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U24785 | (02) |