Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 25MA03052600 | NJ |
NPI | 1013001106 |
---|---|
Provider Name | Marc H. Lavietes |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07103-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205702 | (05) | NJ |