Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MB03091800 | NJ |
Y | 111NI0900X | Internist | 25MB03091800 | NJ |
N | 207RA0401X | Internist - Addiction Medicine | XD3165075 | NJ |
NPI | 1063460939 |
---|---|
Provider Name | John Daconti |
First Address | Newark, NJ 07105-3612 |
Second Address | Belleville, NJ 07109-4143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 15/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1287001 | (05) | NJ |
C60796 | (02) | NJ |