Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MA29301 | NJ |
NPI | 1144336892 |
---|---|
Provider Name | Dr. Raymond S Wojtalik |
First Address | Haddonfield, NJ 08033-1341 |
Second Address | Haddonfield, NJ 08033-1341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 15/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53997 | (02) |