Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 24MA03441900 | NJ |
NPI | 1336497106 |
---|---|
Provider Name | Dr. Yolanda I Dagnino |
First Address | Cedar Grove, NJ 07009-1111 |
Second Address | Cedar Grove, NJ 07009-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 27/08/2012 |