Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MA063604 | NJ |
NPI | 1144269440 |
---|---|
Provider Name | Jeffrey Whitworth |
First Address | West Paterson, NJ 07424-2559 |
Second Address | West Paterson, NJ 07424-2559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 30/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0376198000 | AMERIHEALTH (01) | |
223812197 | HORIZON BCBS (01) | |
2299410 | GHI (01) | |
2881489 | AETNA (01) | |
2K3839 | HEALTHNET (01) | |
31686 | UNIVERSITY HEALTH PLAN (01) | |
60000896 | MHP (01) | |
8050708 | (05) | NJ |
91000267201 | AMERICHOICE (01) | |
G74522 | (02) | |
P2145328 | OXFORD (01) |