Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA07507600 | NJ |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 25MA07507600 | NJ |
NPI | 1114912052 |
---|---|
Provider Name | Antoine Alexandra Lespinasse |
First Address | Montclair, NJ 07042-1914 |
Second Address | Voorhees, NJ 08043-3520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 15/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0024945 | (05) | NJ |
2085801 | (05) | MA |
I00891 | (02) |