Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25MA05069200 | NJ |
NPI | 1396768651 |
---|---|
Provider Name | Misbah Us Salam |
First Address | Newark, NJ 07112-2016 |
Second Address | Newark, NJ 07112-2016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7284101 | (05) | NJ |
G60887 | (02) | NJ |