Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 047306 | CT |
NPI | 1174720536 |
---|---|
Provider Name | Peter Anthony Sarkos |
First Address | Vineland, NJ 08360-5306 |
Second Address | Vineland, NJ 08360-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MB08776300 | NJ LICENSE (01) | NJ |