Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 18885 | NJ |
NPI | 1144419433 |
---|---|
Provider Name | Dr. Mohammad A Kheiralla |
First Address | Succasunna, NJ 07876-1311 |
Second Address | Succasunna, NJ 07876-1311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 23/10/2007 |