Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 9801647 | NC |
NPI | 1063496149 |
---|---|
Provider Name | Dr. Mamta Fuloria |
First Address | Chatham, NJ 07928-1448 |
Second Address | Chatham, NJ 07928-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 05/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H12940 | (02) |