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General NPI Number Information
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NPI Number | 1114563236
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Entity Type | Individual
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Provider Name | DANIEL G BOWDEN
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Gender | Male
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Dates
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Enumeration Date | 11/24/2019
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Last Update Date | 11/24/2019
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Provider Practice Location Address
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Address Line | 82 NEWARK POMPTON TPKE
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City | RIVERDALE
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State | NJ
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Zip | 07457-1427
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Country | US
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Telephone | 973-831-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 82 NEWARK POMPTON TPKE
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City | RIVERDALE
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State | NJ
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Zip | 07457-1427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 29VI00727700
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License Number State | NJ
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