Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 25MA07395100 | NJ |
NPI | 1073842159 |
---|---|
Provider Name | Dr. Samuel David Maldonado |
First Address | Flemington, NJ 08822-5506 |
Second Address | Flemington, NJ 08822-5506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2009 |
Last Update Date | 18/12/2009 |