Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA07065800 | NJ |
N | 208600000X | Surgeon | 25MA07065800 | NJ |
Y | 2086X0206X | Surgical Oncologist | 25MA07065800 | NJ |
NPI | 1235241597 |
---|---|
Provider Name | Dr. Diana M Addis |
First Address | Denville, NJ 07834-1374 |
Second Address | Sparta, NJ 07871-1777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 29/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H70593 | (02) | NJ |