Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | MA68703 | NJ |
Y | 207WX0107X | Retina Specialist | 25MA06870300 | NJ |
NPI | 1013925254 |
---|---|
Provider Name | Dr. Steven Madreperla |
First Address | Union, NJ 07083-7991 |
Second Address | Union, NJ 07083-7991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 01/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F61330 | (02) | NJ |