Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | MA72027 | NJ |
NPI | 1235239328 |
---|---|
Provider Name | Mark Granick |
First Address | Livingston, NJ 07039-4213 |
Second Address | Newark, NJ 19103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6762409 | (05) | NJ |
B34868 | (02) | NJ |