Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22962 | NJ |
NPI | 1013097294 |
---|---|
Provider Name | Dr. Wendy S. Brill |
First Address | Ridgewood, NJ 07450-3957 |
Second Address | Ridgewood, NJ 07450-3957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |