Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 25MA04844000 | NJ |
NPI | 1891793204 |
---|---|
Provider Name | Frank J Scaccia |
First Address | Red Bank, NJ 07701-1851 |
Second Address | Red Bank, NJ 07701-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F34341 | (02) |