Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA06780300 | NJ |
Y | 2084N0402X | Child Neurologist | 25MA067803 | NJ |
NPI | 1144277211 |
---|---|
Provider Name | Dr. Rolando Sousa |
First Address | Wayne, NJ 07470-4956 |
Second Address | Hackensack, NJ 07601-1997 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 27/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0092886 | (05) | NJ |