Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 049990 | CT |
Y | 2086S0102X | Surgical Critical Care | 25MA08787500 | NJ |
NPI | 1184948861 |
---|---|
Provider Name | Anastasia Kunac |
First Address | Newark, NJ 07103-2496 |
Second Address | Newark, NJ 07103-2496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2010 |
Last Update Date | 09/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001499904 | (05) | CT |