Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 25MA03313800 | NJ |
NPI | 1033139464 |
---|---|
Provider Name | Pedro A Solis |
First Address | Hazlet, NJ 07730-1600 |
Second Address | Hazlet, NJ 07730-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D96517 | (02) |