Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MA63154 | NJ |
NPI | 1023006095 |
---|---|
Provider Name | Dr. Mary Beth Witkowski |
First Address | Holmdel, NJ 07733-1519 |
Second Address | Holmdel, NJ 07733-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0644121000 | AMERIHEALTH (01) | NJ |
1K3601 | HEALTHNET (01) | NJ |
7393709 | (05) | NJ |
G58174 | (02) | NJ |
P1278196 | OXFORD (01) | NJ |