Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI02320200 | NJ |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 22DI01069000 | NJ |
NPI | 1568626612 |
---|---|
Provider Name | Dr. Elisa Marie Bland |
First Address | Shrewsbury, NJ 07702-4322 |
Second Address | Shrewsbury, NJ 07702-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 13/08/2019 |