Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI02193000 | NJ |
NPI | 1073575759 |
---|---|
Provider Name | Hani F. Braidy |
First Address | Newark, NJ 07103-2495 |
Second Address | Newark, NJ 07103-2495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 06/04/2015 |