Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25MA10268100 | NJ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 25MA10268100 | NJ |
NPI | 1063828762 |
---|---|
Provider Name | Jared Preston |
First Address | Boston, MA 02241-6457 |
Second Address | New Providence, NJ 07974-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 14/12/2020 |