Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 25MA04348000 | NJ |
NPI | 1043324668 |
---|---|
Provider Name | Dr. Sithiporn Sastrasinh |
First Address | Bernardsville, NJ 07924 |
Second Address | East Orange, NJ 07018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |