Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MA021931 | NJ |
NPI | 1033132063 |
---|---|
Provider Name | Mr. Martin Dorenbush |
First Address | Montville, NJ 07045 |
Second Address | Montville, NJ 07045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52784 | (02) |