Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 25MA07491800 | NJ |
NPI | 1023067741 |
---|---|
Provider Name | Dr. Kathryn P Childs |
First Address | Montclair, NJ 07042-3412 |
Second Address | Montclair, NJ 07042-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 27/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16083 | (02) | NJ |