Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MA07221300 | NJ |
NPI | 1023089554 |
---|---|
Provider Name | Robert Nossa |
First Address | Montclair, NJ 07042-1905 |
Second Address | Verona, NJ 07044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34437 | (02) |