Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MB050538 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | MB050538 | NJ |
NPI | 1093721292 |
---|---|
Provider Name | Joseph Brian Liotti |
First Address | Fairfield, NJ 07004-1571 |
Second Address | Fairfield, NJ 07004-1571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E79079 | (02) | NJ |