Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 25MA07638500 | NJ |
N | 2080P0205X | Pediatric Endocrinologist | MA76385 | NJ |
NPI | 1396760450 |
---|---|
Provider Name | Ian Marshall |
First Address | Red Bank, NJ 07701 |
Second Address | New Brunswick, NJ 08901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0075272 | (05) | NJ |