Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DI 17277 | NJ |
NPI | 1104924489 |
---|---|
Provider Name | Dr. Gayle B. Elbaum |
First Address | Ocean, NJ 07712-3543 |
Second Address | Ocean, NJ 07712-3543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |