Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 53255 | NJ |
NPI | 1134120686 |
---|---|
Provider Name | Richard M Neibart |
First Address | Morristown, NJ 07960-6136 |
Second Address | Neptune, NJ 07753-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 16/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1657500 | (05) | NJ |
E52643 | (02) |