Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 048737 | CT |
N | 207Q00000X | Family Doctor | 25MA0883500 | NJ |
NPI | 1003012410 |
---|---|
Provider Name | Dr. Lorelane Pagulayan Tindoc |
First Address | Clifton, NJ 07012-1923 |
Second Address | Clifton, NJ 07012-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 06/07/2011 |