Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | DO2480900 | NJ |
NPI | 1376970061 |
---|---|
Provider Name | Wesley Chodos |
First Address | Lumberton, NJ 08048-4862 |
Second Address | Lumberton, NJ 08048-4862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2013 |
Last Update Date | 26/09/2013 |