Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MA073550 | NJ |
NPI | 1093750069 |
---|---|
Provider Name | Dr. Qing Tai |
First Address | Bridgewater, NJ 08807-3341 |
Second Address | Bridgewater, NJ 08807-3341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 28/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y38410 | (02) | NJ |