Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 220228 | NY |
Y | 207RN0300X | Nephrologist | 25MA08176800 | NJ |
NPI | 1053319962 |
---|---|
Provider Name | Dr. Mervat B Mansour |
First Address | East Brunswick, NJ 08816 |
Second Address | East Brunswick, NJ 08816-5824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02139802 | (05) | NY |
H33853 | (02) | NY |