Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DI02304800 | NJ |
NPI | 1043423585 |
---|---|
Provider Name | Frederic Lavoie |
First Address | New York, NY 10069-0801 |
Second Address | River Edge, NJ 07661-2591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |