Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00333100 | NJ |
NPI | 1053730143 |
---|---|
Provider Name | Elizabeth Anthony |
First Address | Randolph, NJ 07869-4453 |
Second Address | Randolph, NJ 07869-4453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 31/08/2020 |