Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB06900900 | NJ |
NPI | 1952416588 |
---|---|
Provider Name | Dr. Paul William Prosperi |
First Address | Ship Bottom, NJ 08008-4443 |
Second Address | Ship Bottom, NJ 08008-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 05/07/2011 |