Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA05504900 | NJ |
NPI | 1164447587 |
---|---|
Provider Name | Dr. Loreta Montolo Uy |
First Address | Newark, NJ 07105-3612 |
Second Address | Newark, NJ 07105-3612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA05504900 | MEDICAL LICENSE (01) | NJ |
3438708 | (05) | NJ |