Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 25MA07844300 | NJ |
NPI | 1619066636 |
---|---|
Provider Name | Thomas Scanlin JR. |
First Address | Tinton Falls, NJ 07701-4947 |
Second Address | New Brunswick, NJ 08901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 06/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2179806 | (05) | NJ |
C27923 | (02) | NJ |