Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00116800 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00116800 | NJ |
NPI | 1053486100 |
---|---|
Provider Name | Dr. Ronald Marc Sidorsky |
First Address | Denville, NJ 07834 |
Second Address | Denville, NJ 07834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 20/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44809 | (02) |