Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA63223 | NJ |
NPI | 1902808991 |
---|---|
Provider Name | Warren M Kraus |
First Address | South Plainfield, NJ 07080-0707 |
Second Address | Edison, NJ 08820-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 15/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G19629 | (02) | NJ |