Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25MA10113200 | NJ |
NPI | 1003158718 |
---|---|
Provider Name | Dr. Anna Korban |
First Address | Newark, NJ 07103-2496 |
Second Address | Newark, NJ 07103-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 01/09/2017 |