Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MA080015 | NJ |
NPI | 1164473864 |
---|---|
Provider Name | Sean Louis Lager |
First Address | Clifton, NJ 07013-1900 |
Second Address | Clifton, NJ 07013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 24/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I32704 | (02) | NJ |