Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 25MA07886700 | NJ |
NPI | 1013952084 |
---|---|
Provider Name | Jonathan E Blume |
First Address | Westwood, NJ 07675-2616 |
Second Address | Westwood, NJ 07675-2616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 07/11/2007 |