Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD419188 | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD419188 | PA |
NPI | 1265451066 |
---|---|
Provider Name | Jeffrey M Skolnik |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0076732 | (05) | NJ |
101374287 | (05) | PA |
I39005 | (02) |