Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD001314NJ | NJ |
Y | 222Z00000X | Podiatrist | 25MD001314NJ | NJ |
NPI | 1053496398 |
---|---|
Provider Name | Eric M Deutchman |
First Address | Linden, NJ 07036 |
Second Address | Linden, NJ 07036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T77760 | (02) | NJ |