Individual
MR. SAMUEL FANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
214 COTTER AVE, NEPTUNE, NJ 07753-3702
(732) 682-4272
Mailing address
214 COTTER AVE, NEPTUNE, NJ 07753-3702
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
04/22/2020
Last updated
04/22/2020
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