Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MA23838 | NJ |
N | 208600000X | Surgeon | MA23838 | NJ |
Y | 2086S0129X | Vascular Surgeon | MA23838 | NJ |
NPI | 1104891803 |
---|---|
Provider Name | Stephen F Konigsberg |
First Address | Highland Park, NJ 08904-1731 |
Second Address | Highland Park, NJ 08904-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 22/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0117609 | (05) | NJ |
C59894 | (02) |