Individual
NIV MOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 CENTRAL AVE STE 500, NEW PROVIDENCE, NJ 07974-1505
(908) 795-1194
Mailing address
PO BOX 416457, BOSTON, MA 02241-6457
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
25MA10331100
NJ
207Y00000X
Otolaryngology Physician
272346-1
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
04/01/2009
Last updated
01/25/2022
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