Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MAO5867000 | NJ |
NPI | 1003951112 |
---|---|
Provider Name | Dorota Malyszek Gribbin |
First Address | Mercerville, NJ 08619-1946 |
Second Address | Mercerville, NJ 08619-1946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 21/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F39980 | (02) | NJ |