Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA11062200 | NJ |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD473885 | PA |
NPI | 1013371657 |
---|---|
Provider Name | Gileno Oliveira Fonseca Filho |
First Address | Sewell, NJ 08080-2359 |
Second Address | Voorhees, NJ 08043-4796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2016 |
Last Update Date | 26/08/2021 |