Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA0628900 | NJ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 29924 | IA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME90906 | FL |
NPI | 1023110749 |
---|---|
Provider Name | Fred A Kobylarz |
First Address | Tinton Falls, NJ 07701-4947 |
Second Address | Monroe Township, NJ 08831-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 21/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6933904 | (05) | NJ |
G53098 | (02) |