Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | C10003991 | DE |
NPI | 1053401794 |
---|---|
Provider Name | Dr. Neil A Izenberg |
First Address | Wilmington, DE 19899 |
Second Address | Wilmington, DE 19899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0689117 (PA) | (05) | DE |
C32469 | (02) |