Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MA56642 | NJ |
NPI | 1003851288 |
---|---|
Provider Name | Dr. Philip John Filippis II |
First Address | Wayne, NJ 07470-2110 |
Second Address | Wayne, NJ 07470-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5480302 | (05) | NJ |
F51541 | (02) | NJ |