Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA02730000 | NJ |
NPI | 1073679510 |
---|---|
Provider Name | Dr. Ethel D Baruiz |
First Address | Totowa, NJ 07512-1803 |
Second Address | Totowa, NJ 07512-1803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA02730000 | LICENSE NUMBER (01) | NJ |
E58970 | (02) | NJ |