Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 25MA05474200 | NJ |
NPI | 1366411084 |
---|---|
Provider Name | Elizabeth K Mammen-Prasad |
First Address | Irvington, NJ 07111-3262 |
Second Address | Irvington, NJ 07111-3262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F36367 | (02) | NJ |