Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DI078613 | NJ |
NPI | 1831110345 |
---|---|
Provider Name | Dr. Robert J Defalco |
First Address | Paramus, NJ 07652-1433 |
Second Address | Paramus, NJ 07652-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8069506 | (05) | NJ |