Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22DI02332100 | NJ |
NPI | 1043411085 |
---|---|
Provider Name | Divya Jha |
First Address | New York, NY 10023-7015 |
Second Address | Closter, NJ 07624-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |