Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 25MA02500200 | NJ |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 25MA02500200 | NJ |
NPI | 1629118872 |
---|---|
Provider Name | Franklin Desposito |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07103-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 18/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0985805 | (05) | NJ |
E30069 | (02) | NJ |