Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25MA10647800 | NJ |
NPI | 1003344920 |
---|---|
Provider Name | Jose Deschamps |
First Address | Newark, NJ 07103-2775 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 13/01/2021 |