Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DI15764 | NJ |
Y | 213EG0000X | General Practice | DI15764 | NJ |
NPI | 1003944786 |
---|---|
Provider Name | Rick Dadouris |
First Address | Clinton, NJ 08809-1023 |
Second Address | Clinton, NJ 08809-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |