Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 62518 | NJ |
NPI | 1346285434 |
---|---|
Provider Name | Dr. Philippe Chemaly |
First Address | Wayne, NJ 07470-2154 |
Second Address | Wayne, NJ 07470-2154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7366701 | (05) | NJ |
G57115 | (02) | NJ |