Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 25MA07770000 | NJ |
NPI | 1164499786 |
---|---|
Provider Name | Gregory Gerard Fedorcik |
First Address | Eatontown, NJ 07724 |
Second Address | Eatontown, NJ 07724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0103667 | (05) | NJ |
I50656 | (02) |