Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22DI 02136700 | NJ |
NPI | 1073789582 |
---|---|
Provider Name | Dr. Marlene Imelda Oviedo-Marmo |
First Address | Medford, NJ 08055-9281 |
Second Address | Medford, NJ 08055-9281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2008 |
Last Update Date | 05/05/2008 |