Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NJ 1720 | NJ |
NPI | 1073718177 |
---|---|
Provider Name | Robert Frank Ceragno |
First Address | North Bergen, NJ 07047-4966 |
Second Address | North Bergen, NJ 07047-4966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0024074 | (05) | NJ |