Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | D117856 | NJ |
NPI | 1003999384 |
---|---|
Provider Name | Jorge Barrios |
First Address | Ho Ho Kus, NJ 07423 |
Second Address | Ho Ho Kus, NJ 07423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |