Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 17511 | NJ |
NPI | 1104860196 |
---|---|
Provider Name | Dr. Robert S. Fiedler |
First Address | Linwood, NJ 08221-2025 |
Second Address | Linwood, NJ 08221-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T77590 | (02) | NJ |