Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA7185500 | NJ |
NPI | 1275543365 |
---|---|
Provider Name | Dr. Wendy Neal |
First Address | Newark, NJ 07112-2016 |
Second Address | Newark, NJ 07112-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F96786 | (02) | NJ |
F96786 | (02) | NY |