Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 38MC00372100 | NJ |
NPI | 1710104518 |
---|---|
Provider Name | Dr. Vincent Gerard Kiechlin |
First Address | Princeton, NJ 08540-2757 |
Second Address | Princeton, NJ 08540-2757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KI621692 | (02) | NJ |