Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25MA09150700 | NJ |
NPI | 1053516765 |
---|---|
Provider Name | Dr. Evelyne Kalyoussef |
First Address | Newark, NJ 07103 |
Second Address | Newark, NJ 07103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 12/09/2012 |