Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 25MA07393400 | NJ |
NPI | 1285652164 |
---|---|
Provider Name | Mario G Arredondo |
First Address | Red Bank, NJ 07701-5201 |
Second Address | Red Bank, NJ 07701-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H09971 | (02) | NJ |