Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD00356800 | NJ |
N | 2081S0010X | Sports Medicine | 25MD00356800 | NJ |
N | 213ES0000X | Sports Medicine | 25MD00356800 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00356800 | NJ |
N | 213ES0131X | Foot Surgery | 25MD00356800 | NJ |
NPI | 1144751926 |
---|---|
Provider Name | Daniella Renee Menillo |
First Address | Pine Brook, NJ 07058-9425 |
Second Address | Rochelle Park, NJ 07662-3916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 05/11/2020 |