Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 38MC00780000 | NJ |
NPI | 1659966919 |
---|---|
Provider Name | Jeffrey Simoes Santos |
First Address | Cliffwood, NJ 07721-1508 |
Second Address | Middletown, NJ 07748-2251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2021 |
Last Update Date | 08/03/2021 |