Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MA75436 | NJ |
NPI | 1063635332 |
---|---|
Provider Name | Evelyn Camacho-Patterson |
First Address | Chatham, NJ 07928-0448 |
Second Address | North Bergen, NJ 07047-5527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G70743 | (02) |