Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 19245 | NJ |
NPI | 1235299421 |
---|---|
Provider Name | Shankar Iyer |
First Address | Elizabeth, NJ 07208 |
Second Address | Elizabeth, NJ 07208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7221606 | (05) | NJ |