Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MA70852 | NJ |
NPI | 1194789008 |
---|---|
Provider Name | Richard S Nachwalter |
First Address | Morristown, NJ 07960-7360 |
Second Address | Morristown, NJ 07960-7360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H23496 | (02) | NJ |