Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MMAO7471600 | NJ |
NPI | 1336107325 |
---|---|
Provider Name | Dr. Lisa Kim Ellman-Grunther |
First Address | Fairfield, NJ 07004-7205 |
Second Address | New York, NY 10006-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 09/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8970700 | (05) | NJ |
H69869 | (02) | NJ |