Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 25MA09709700 | NJ |
Y | 208600000X | Surgeon | 25MA09709700 | NJ |
N | 2086S0102X | Surgical Critical Care | 25MA09709700 | NJ |
NPI | 1144462615 |
---|---|
Provider Name | John Andre Pepen |
First Address | Springfield, NJ 07081 |
Second Address | Springfield, NJ 07081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 16/05/2016 |