Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00357600 | NJ |
NPI | 1063586881 |
---|---|
Provider Name | Dr. Kaltheen Sue Ann Rebisz |
First Address | Garfield, NJ 07026-1600 |
Second Address | Garfield, NJ 07026-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |