Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA064444 | NJ |
NPI | 1255412391 |
---|---|
Provider Name | Dr. Mary Rose Ramos Gallardo |
First Address | Brick, NJ 08724 |
Second Address | Brick, NJ 08724-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |