Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA09602700 | NJ |
N | 207X00000X | Orthopaedic Surgeon | MD067966L | PA |
NPI | 1992779763 |
---|---|
Provider Name | Jack W Shilling |
First Address | Camden, NJ 08103-1088 |
Second Address | Voorhees, NJ 08043-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 04/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H19290 | (02) |