Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 25MA06061600 | NJ |
NPI | 1326016304 |
---|---|
Provider Name | Eveline C Traeger |
First Address | Mountainside, NJ 07092-2590 |
Second Address | Mountainside, NJ 07092-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 14/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6183603 | (05) | NJ |
F82217 | (02) | NJ |