Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25MA04236800 | NJ |
N | 207KA0200X | Allergist | 25MA04236800 | NJ |
N | 207RA0201X | Internist - Allergy & Immunology | 25MA04236800 | NJ |
N | 2080P0201X | Pediatric Allergist | 25MA04236800 | NJ |
NPI | 1407906282 |
---|---|
Provider Name | Philip Lawrence Case |
First Address | Freehold, NJ 07728-3258 |
Second Address | Freehold, NJ 07728-3258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 27/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C31964 | (02) | NJ |