Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA00603500 | NJ |
NPI | 1003082108 |
---|---|
Provider Name | Aleksandra Iwanczyk |
First Address | Somerset, NJ 08873-3670 |
Second Address | Somerset, NJ 08873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |