Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MA72068 | NJ |
NPI | 1740335892 |
---|---|
Provider Name | Dr. Phillip Sunil Devadan |
First Address | Bloomingdale, NJ 07403-1921 |
Second Address | Pompton Plains, NJ 07444-1647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203BP02004 | TAXONOMY (01) | NJ |