Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MA57386 | NJ |
NPI | 1043289184 |
---|---|
Provider Name | Jose Fune |
First Address | Neptune, NJ 07753-4488 |
Second Address | Neptune, NJ 07753-4488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 13/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G24628 | (02) | NJ |