Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA02287300 | NJ |
NPI | 1003101403 |
---|---|
Provider Name | Randolph R. Estwick |
First Address | Harrington Park, NJ 07640 |
Second Address | Harrington Park, NJ 07640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 14/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C-12529 | (02) | NJ |