Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00172300 | NJ |
NPI | 1013095975 |
---|---|
Provider Name | Mr. Anthony J Enrico |
First Address | Paterson, NJ 07514-1918 |
Second Address | Paterson, NJ 07514-1918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 24/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T45989 | (02) | NJ |