Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25MA10088800 | NJ |
NPI | 1245525294 |
---|---|
Provider Name | Ismar Dizdarevic |
First Address | Ridgewood, NJ 07450-4561 |
Second Address | Ridgewood, NJ 07450-4561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 26/04/2019 |