Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | QA04262 | NJ |
N | 2251N0400X | Physical Therapist - Neurology | QA04262 | NJ |
NPI | 1033396601 |
---|---|
Provider Name | Mark Edward Raum |
First Address | Cedar Grove, NJ 07009-1402 |
Second Address | Cedar Grove, NJ 07009-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2008 |
Last Update Date | 26/01/2008 |