Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI02699900 | NJ |
NPI | 1003278375 |
---|---|
Provider Name | Camille Marquis |
First Address | Nutley, NJ 07110-2973 |
Second Address | Nutley, NJ 07110-2973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 18/05/2021 |