Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA41952 | NJ |
NPI | 1255300059 |
---|---|
Provider Name | Dr. Ilene M Hershman |
First Address | Mine Hill, NJ 07803-3133 |
Second Address | Mine Hill, NJ 07803-3133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56666 | (02) | NJ |