Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA053514 | NJ |
NPI | 1285650523 |
---|---|
Provider Name | Elizabeth Rose |
First Address | Bernardsville, NJ 07924-2262 |
Second Address | Bernardsville, NJ 07924-2262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1577603 | (05) | NJ |
H03935 | (02) | NJ |