Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 25MA08993900 | NJ |
Y | 207RG0300X | Geriatric Medicine | MD12634 | RI |
NPI | 1124282033 |
---|---|
Provider Name | Roland Jerzy Losos |
First Address | Lyndhurst, NJ 07071-1462 |
Second Address | Lyndhurst, NJ 07071-1462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 14/12/2011 |