Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 25MA03012300 | NJ |
NPI | 1528165487 |
---|---|
Provider Name | Dr. S Jose Fishman |
First Address | Kearny, NJ 07032-3003 |
Second Address | Kearny, NJ 07032-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D06411 | (02) | NJ |