Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 25MA02516200 | NJ |
NPI | 1043310907 |
---|---|
Provider Name | Mr. Zem Walk |
First Address | West Orange, NJ 07052-1102 |
Second Address | West Orange, NJ 07052-1102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53706 | (02) |