Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00207600 | NJ |
NPI | 1427088517 |
---|---|
Provider Name | Ralph Ernesto |
First Address | Manalapan, NJ 07728 |
Second Address | Eatontown, NJ 07724-9621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 18/10/2010 |