Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 23390 | NJ |
NPI | 1073574059 |
---|---|
Provider Name | George Beecher |
First Address | Warren, NJ 07059 |
Second Address | Warren, NJ 07059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23390 | STATE LIC (01) | NJ |
E53423 | (02) |