Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 25MB08070100 | NJ |
Y | 213ES0000X | Sports Medicine | 25MB08070100 | NJ |
NPI | 1558314047 |
---|---|
Provider Name | Frank John Colarusso |
First Address | Hamilton, NJ 08691-3386 |
Second Address | Hamilton, NJ 08691 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H48734 | (02) | MA |
PENDING | (05) | NJ |