Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25MA02355100 | NJ |
NPI | 1003896218 |
---|---|
Provider Name | Dr. Richard M. Latkin |
First Address | Woodcliff Lake, NJ 07677-8409 |
Second Address | Woodcliff Lake, NJ 07677-8409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C62906 | (02) | NJ |