Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MA54937 | NJ |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MA05493700 | NJ |
NPI | 1043315401 |
---|---|
Provider Name | Dr. Philip J. Therrien |
First Address | East Brunswick, NJ 08816 |
Second Address | East Brunswick, NJ 08816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
166901 | (05) | NJ |
E56445 | (02) | NJ |