Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 8216 | NJ |
NPI | 1043478977 |
---|---|
Provider Name | Edward J Kuch |
First Address | Fair Haven, NJ 07704-3311 |
Second Address | Fair Haven, NJ 07704-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 28/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6271201 | (05) | NJ |