Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00343200 | NJ |
NPI | 1023429651 |
---|---|
Provider Name | Zachary Criswell |
First Address | Newark, NJ 07107-3000 |
Second Address | Paramus, NJ 07652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2014 |
Last Update Date | 30/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0664286 | (05) | NJ |