Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MB55529 | NJ |
NPI | 1558346825 |
---|---|
Provider Name | Ronald Joseph Iannacone |
First Address | Manasquan, NJ 08736-2609 |
Second Address | Manasquan, NJ 08736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6217401 | (05) | NJ |
G08253 | (02) |