Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00103800 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00103800 | NJ |
NPI | 1033125174 |
---|---|
Provider Name | Dr. Steven Deitch |
First Address | Red Bank, NJ 07701 |
Second Address | Red Bank, NJ 07701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3325407 | (05) | NJ |
T77787 | (02) |