Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | MB026044 | NJ |
NPI | 1457323420 |
---|---|
Provider Name | Gary S Packin |
First Address | Voorhees, NJ 08043-0536 |
Second Address | Marlton, NJ 08053-4161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52622 | (02) | NJ |