Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 25MB08183900 | NJ |
NPI | 1013176247 |
---|---|
Provider Name | Dr. Fani Jacqueline Thomson |
First Address | Fair Lawn, NJ 07410-2400 |
Second Address | Paramus, NJ 07652-3628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |