Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1114579745 |
---|---|
Provider Name | Diane Merkovsky |
First Address | Dumont, NJ 07628-2907 |
Second Address | Dumont, NJ 07628-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2019 |
Last Update Date | 13/07/2019 |