Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 26NJ00909300 | NJ |
NPI | 1023672417 |
---|---|
Provider Name | Mr. Matthew R Soos |
First Address | Atlantic City, NJ 08401-6713 |
Second Address | Atlantic City, NJ 08401-6713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 01/05/2019 |