Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 38MC00524400 | NJ |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00816800 | NJ |
NPI | 1063583250 |
---|---|
Provider Name | Thomas Campione |
First Address | Cresskill, NJ 07626-2203 |
Second Address | Cresskill, NJ 07626-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 08/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U72715 | (02) | NJ |