Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI02495200 | NJ |
NPI | 1003195322 |
---|---|
Provider Name | Dr. Marisa Lauren Handelman |
First Address | Howell, NJ 07731-4017 |
Second Address | Howell, NJ 07731-4017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2011 |
Last Update Date | 17/06/2013 |