Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | NJ |
NPI | 1063531556 |
---|---|
Provider Name | Marco Antonio Pelosi III |
First Address | Bayonne, NJ 07002-1313 |
Second Address | Bayonne, NJ 07002-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14429 | (02) | NJ |