Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 250979 | NY |
Y | 2080P0205X | Pediatric Endocrinologist | 250979 | NY |
NPI | 1326210485 |
---|---|
Provider Name | Dr. Irene Mamkin |
First Address | West Orange, NJ 07052-2724 |
Second Address | West Orange, NJ 07052-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2008 |
Last Update Date | 03/02/2014 |