Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MA032190 | NJ |
NPI | 1033215298 |
---|---|
Provider Name | Edward M Decter |
First Address | West Orange, NJ 07052-2956 |
Second Address | West Orange, NJ 07052-2956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 20/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C61005 | (02) | NJ |