Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00654000 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00654000 | NJ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00654000 | NJ |
NPI | 1063944973 |
---|---|
Provider Name | Lenny Syriac George |
First Address | Belleville, NJ 07109-1816 |
Second Address | Berkeley Heights, NJ 07922-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 30/03/2017 |