Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MA19413 | NJ |
NPI | 1164400313 |
---|---|
Provider Name | Joseph Anthony Varallo |
First Address | Egg Harbor Township, NJ 08234-0000 |
Second Address | Egg Harbor Township, NJ 08234-8353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 21/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53452 | (02) | NJ |