Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA03838700 | NJ |
NPI | 1265605919 |
---|---|
Provider Name | Dr. Susan Eleanor Skalsky Bales |
First Address | Caldwell, NJ 07006-5804 |
Second Address | Caldwell, NJ 07006-5804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 20/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F19215 | (02) | NJ |