Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 25MA05724000 | NJ |
NPI | 1033246897 |
---|---|
Provider Name | Ellen Monahan |
First Address | Newark, NJ 07107-3000 |
Second Address | Newark, NJ 07103-2496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 26/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6403701 | (05) | NJ |