Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA04602400 | NJ |
N | 208000000X | Pediatrician | MD031017E | PA |
Y | 2080P0201X | Pediatric Allergist | 25MA04602400 | NJ |
N | 2080P0201X | Pediatric Allergist | MD031017E | PA |
NPI | 1346259363 |
---|---|
Provider Name | Joel M Fiedler |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Voorhees, NJ 08043-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 03/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001614710 | (05) | PA |
0477702 | (05) | NJ |
D91736 | (02) |