Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0205X | Pediatric Endocrinologist | 1064061 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 25MA03138700 | NJ |
NPI | 1366496572 |
---|---|
Provider Name | Michael Novogroder |
First Address | Teaneck, NJ 07666-3144 |
Second Address | Teaneck, NJ 07666-3144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 05/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C57015 | (02) | NJ |