Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00147500 | NJ |
NPI | 1528047164 |
---|---|
Provider Name | Dr. Linda Barney St. Martin |
First Address | Voorhees, NJ 08043-9521 |
Second Address | Voorhees, NJ 08043-9521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 23/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129500401 | (05) | NJ |
T73104 | (02) | NJ |