Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 25MA07103600 | NJ |
NPI | 1114997426 |
---|---|
Provider Name | Michael Ombrellino |
First Address | Westfield, NJ 07090-2520 |
Second Address | Morristown, NJ 07960-6092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 23/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H16611 | (02) | NJ |