Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 25MA03882300 | NJ |
NPI | 1003862368 |
---|---|
Provider Name | Joseph Rozdeba |
First Address | Wallington, NJ 07057-1300 |
Second Address | Wallington, NJ 07057-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1091905 | (05) | NJ |