Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 25MA04234900 | NJ |
NPI | 1245313931 |
---|---|
Provider Name | Suresh Chander Giri |
First Address | Lakewood, NJ 08701 |
Second Address | Lakewood, NJ 08701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA04234900 | NJ LICS (01) | NJ |
3376001 | (05) | NJ |
AG2160187 | DEA (01) | |
E36001 | (02) |