Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MA07609100 | NJ |
NPI | 1003805763 |
---|---|
Provider Name | Dr. Annamarie Ibay |
First Address | Mount Laurel, NJ 08054-3917 |
Second Address | Lumberton, NJ 08048-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0042871 | (05) | NJ |
I21378 | (02) | NJ |