Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MA05970500 | NJ |
NPI | 1275572034 |
---|---|
Provider Name | Dr. Milinda Ruth Carson |
First Address | Passaic, NJ 07055-4717 |
Second Address | Passaic, NJ 07055-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6939902 | (05) | NJ |
G25215 | (02) | NJ |