Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00673300 | NJ |
N | 111NN0400X | Neurology | 09784 | TX |
N | 111NN0400X | Neurology | 38MC00673300 | NJ |
NPI | 1770758583 |
---|---|
Provider Name | Dr. Seiichiro Ando |
First Address | Edgewater, NJ 07020-1171 |
Second Address | Edgewater, NJ 07020-1149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 08/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165350 | MEDICARE PTAN (01) | |
165350YQJV | MEDICARE (01) | |
276920YQJV | MEDICARE (01) |