Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QA02014400 | NJ |
NPI | 1013677889 |
---|---|
Provider Name | Dr. Shraddha Wagh |
First Address | Lawrenceville, NJ 08648 |
Second Address | Lawrenceville, NJ 08648-4703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2021 |
Last Update Date | 21/12/2021 |