Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA06941700 | NJ |
NPI | 1013920867 |
---|---|
Provider Name | Dr. Anita I Miedziak |
First Address | Princeton, NJ 08540 |
Second Address | Princeton, NJ 08540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8561800 | (05) | NJ |
G72146 | (02) | |
G86093 | (02) |