Basic Information
| Provider Information | |||||||||
| NPI: | 1043296320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMERSON | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | LANE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | INDEPENDENT DUTY HS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986860 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986860 | ||||||||
| FaxNumber: | 6098986962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 10/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1710I1002X | Y | Other Service Providers | Military Health Care Provider | Independent Duty Corpsman | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.