Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 248292 | NY |
Y | 207RG0300X | Geriatric Medicine | 25MB08886800 | NJ |
NPI | 1124267091 |
---|---|
Provider Name | Dr. Palak Moondra |
First Address | New Brunswick, NJ 08901-1766 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2009 |
Last Update Date | 25/04/2011 |