Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DIO17413 | NJ |
NPI | 1003027160 |
---|---|
Provider Name | Dr. Laurie Addvensky |
First Address | Ridgewood, NJ 07450-3142 |
Second Address | Ridgewood, NJ 07450-3142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |