Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MA38764 | NJ |
NPI | 1063523892 |
---|---|
Provider Name | Dr. William Kohlberg |
First Address | Freehold, NJ 07728-5305 |
Second Address | Freehold, NJ 07728-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C5422 | (02) | NJ |