Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10829 | NJ |
NPI | 1003980012 |
---|---|
Provider Name | John Anthony Defranco |
First Address | Rockaway, NJ 07866-4017 |
Second Address | Rockaway, NJ 07866-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |