Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 38MC00470600 | NJ |
NPI | 1598815409 |
---|---|
Provider Name | Mark D. Nierenberg |
First Address | Branchburg, NJ 08876-3476 |
Second Address | Branchburg, NJ 08876-3476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 29/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U39598 | (02) | NJ |