Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 25MA07063500 | NJ |
NPI | 1083635940 |
---|---|
Provider Name | Dr. Shilpa Mahendra Clott |
First Address | Warren, NJ 07059-5648 |
Second Address | Warren, NJ 07059-5648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 29/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H50808 | (02) | NJ |