Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 25MA04041100 | NJ |
NPI | 1659351757 |
---|---|
Provider Name | Elaine Karen Kravitz |
First Address | Mount Laurel, NJ 08054-6302 |
Second Address | Mount Laurel, NJ 08054-6302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B96736 | (02) |