Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 964 | MN |
NPI | 1942423728 |
---|---|
Provider Name | Mr. Brian J. Mulcahy |
First Address | Belleville, NJ 07109-1307 |
Second Address | Belleville, NJ 07109-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8502501 | (05) | NJ |