Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA07428000 | NJ |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 25MA07428000 | NJ |
NPI | 1558350215 |
---|---|
Provider Name | Dr. Lynda Bascelli |
First Address | Marlton, NJ 08053-4197 |
Second Address | Berlin, NJ 08009-9035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8920907 | (05) | NJ |