Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 245487 | NY |
N | 208600000X | Surgeon | 245487 | NY |
Y | 2086X0206X | Surgical Oncologist | 25MA08641600 | NJ |
NPI | 1316105711 |
---|---|
Provider Name | Dr. Michelle C Azu |
First Address | Boston, MA 02241-6457 |
Second Address | Pompton Plains, NJ 07444-1647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 05/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0209007 | (05) | NJ |