Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI00905200 | NJ |
NPI | 1053328369 |
---|---|
Provider Name | Ronald Weiner |
First Address | Parsippany, NJ 07054-2142 |
Second Address | Parsippany, NJ 07054-2142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22DI00905200 | NJ REGISTRATION NUMBER (01) | NJ |