Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 25MA08894600 | NJ |
N | 204F00000X | Transplant Surgeon | MT192744 | PA |
NPI | 1407094998 |
---|---|
Provider Name | Ely Sebastian |
First Address | Marlton, NJ 08053-4197 |
Second Address | Camden, NJ 08103-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0260193 | (05) | NJ |