Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA07449000 | NJ |
NPI | 1023062866 |
---|---|
Provider Name | Dusan Knezevic |
First Address | Glen Ridge, NJ 07028-1527 |
Second Address | Glen Ridge, NJ 07028-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9127402 | (05) | NJ |
H27892 | (02) | NJ |