Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 25MD00202400 | NJ |
Y | 222Z00000X | Podiatrist | 25MD00202400 | NJ |
NPI | 1043287741 |
---|---|
Provider Name | Dr. Lorraine Catherine Bopp |
First Address | Brick, NJ 08723 |
Second Address | Brick, NJ 08723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U17872 | (02) |