Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MB069711 | NJ |
NPI | 1174554471 |
---|---|
Provider Name | Dr. Robert A Defalco JR. |
First Address | Hackettstown, NJ 07840-4174 |
Second Address | Hackettstown, NJ 07840-4174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 30/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12244 | (02) | NJ |