Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00264600 | NJ |
NPI | 1619014222 |
---|---|
Provider Name | Dr. Robert J. Failla |
First Address | Avenel, NJ 07001-1433 |
Second Address | Avenel, NJ 07001-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T52564 | (02) | NJ |