Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MD002595 | NJ |
Y | 222Z00000X | Podiatrist | MD002595 | NJ |
NPI | 1033163233 |
---|---|
Provider Name | Dr. Elaine Mariolis |
First Address | Perth Amboy, NJ 08861-4004 |
Second Address | Perth Amboy, NJ 08861-4004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8730105 | (05) | NJ |
U81631 | (02) | NJ |