Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 45PO00014900 | NJ |
N | 222Z00000X | Podiatrist | 45PO00014900 | NJ |
Y | 224P00000X | Prosthetist | 45PO00014900 | NJ |
NPI | 1376510156 |
---|---|
Provider Name | Mr. Richard J Bray |
First Address | Westwood, NJ 07675-3130 |
Second Address | Westwood, NJ 07675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 10/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6885306 | (05) | NJ |