Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA49981 | NJ |
NPI | 1306801568 |
---|---|
Provider Name | Dr. Marilynn Dora Boim |
First Address | Hamilton, NJ 08690-3542 |
Second Address | Hamilton, NJ 08690-3542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0256200 | (05) | NJ |
C54362 | (02) | NJ |