Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00298400 | NJ |
NPI | 1316176068 |
---|---|
Provider Name | Dr. Nicole Dawn Rubackin-Hayward |
First Address | Glen Rock, NJ 07452-1902 |
Second Address | Glen Rock, NJ 07452-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 02/07/2009 |